肝叶切除治疗肝内胆管结石病(附671例分析)

目的探讨肝叶切除在治疗肝内胆管结石病中的效果。方法回顾分析671例肝切除治疗肝内胆管结石病的病变特点、治疗方法和治疗效果。结果根据不同的病变特点行不同的切除方法,所有671例肝内胆管结石病治疗效果良好。结论肝切除是治疗肝内胆管结石病非常有效的方法。     

多处肝叶切除治疗双侧弥漫性肝胆管结石病的临床分析

目的探讨双侧弥漫性肝胆管结石病行多处肝叶切除的手术治疗效果。方法对80例双侧弥漫性肝胆管结石病患者均行规则性肝左外叶切除＋右肝局部楔形切除手术治疗。结果 80例患者均手术效果满意。结论左外叶切除＋右肝局部楔形切除是治疗双侧弥漫性肝胆管结石病的较安全有效的方法之一。     

肝内胆管结石的肝叶切除技术

黄志强院士在我院实行世界上首例肝叶切除治疗肝胆管结石病以来,该方法以其结石清除率高、复发率低等许多优点已成为目前治疗肝胆管结石病最有效的方法之一.肝内胆管结石的肝叶切除不仅能去除病灶,取尽结石,还能为矫正狭窄、通畅引流、防止肝胆管结石的复发提供良好的条件. 1 肝叶切除的目的 1.1 以胆管树为基础的规则性肝叶切除术去除病灶     

肝内胆管结石的外科手术治疗

目的 探讨肝内胆管结石外科治疗效果。方法 收集总结我科１９９１．１－１９９８．５期间手术治疗肝内胆管结石病人的３６５例,分析结石部闰与手术时机,手术方式之间的关系。结果３６５例病人,３５８例治愈,７例死亡,肝内胆管残余结７１例,肝功能衰竭７例。结论肝内胆管结石是一个较难的问题,肝叶切除是治疗的最佳方法。对于不适合行肝叶切除及术后残余结石者应采取多元化系统化的治疗。     

肝叶切除治疗肝内胆管结石487例临床体会

目的探讨肝叶切除治疗肝内胆管结石的方法及疗效。方法回顾性总结1982年1月～2002年6月间肝叶切除治疗487例肝内胆管结石的经验与体会。结果肝左(外)叶切除415例(占肝叶切除的85．2％)；肝方叶切除31例(6．4％)；肝右叶切除41例(8．4％)。术后并发症53例(10．9％)，包括隔下感染、胆道出血等。死亡5例，死亡率1．0％。结论肝叶切除是治疗部分肝内胆管结石的较好方法，但对肝右叶及左右肝胆管结石病例仍有扩大适应证之可能。     

肝叶切除治疗肝内胆管结石487例临床体会

目的　探讨肝叶切除治疗肝内胆管结石的方法及疗效。方法　回顾性总结 1982年 1月 -2 0 0 2年 6月间肝叶切除治疗 487例肝内胆管结石的经验与体会。结果　肝左 (外 )叶切除 415例(占肝叶切除的 85 .2 % ) ;肝方叶切除 3 1例 ( 6.4% ) ;肝右叶切除 41例 ( 8.4% )。术后并发症 5 3例( 10 .9% ) ,包括隔下感染、胆道出血等。死亡 5例 ,死亡率 1.0 %。结论　肝叶切除是治疗部分肝内胆管结石的较好方法 ,但对肝右叶及左右肝胆管结石病例仍有扩大适应证之可能。     

左肝外叶切除术联合胆道镜治疗左肝内胆管结石的临床研究

目的探讨左肝外叶切除联合术中胆道镜治疗左肝内胆管结石的效果。方法对我院2007年1月至2012年12月收治的46例左肝内胆管结石病人同期分别采用两种手术方法治疗。A组25例采用肝左外叶切除联合术中胆道镜取石术;B组21例采用左半肝叶切除术,对两组的术中情况、术后并发症和近期疗效进行分析比较。结果 A组与B组患者的术前一般资料之间差异无统计学意义(P>0.05);A组术中出血量、手术时间和术后并发症的发生率显著低于B组(P<0.05);A组和B组的术后优良率和结石残余率的差异无统计学意义(P>0.05)。结论肝左外叶切除联合术中胆道镜治疗左肝内胆管结石是安全、有效手术方式。     

规则性肝段切除术治疗肝内胆管结石病

目的 总结采用肝段切除术治疗肝内胆管结石病的经验。方法 回顾性分析1975年1月至1998年12月间采用肝段切除术治疗514例肝内胆管结石的临床资料及远期疗效。结果 肝内胆管结石的分布：左外叶64例、左肝叶176例、右前叶10例、右后叶24例、右肝叶31例、双侧肝叶209例。合并症：合并有显著肝段或肝叶萎缩者280例，肝脓肿17例，胆瘘7例，胆管癌8例。265例有1-5次胆道手术史。手术方法：根据肝内结石的分布决定肝段或联合肝段切除的范围，其中S2－3切除284例、切除98例、切除26例、切除37例、双侧肝叶部分切除23例。附加术式包括经肝门胆管切开取石217例，经肝实质肝内胆管切开取石11例，胆管空肠Roux-en-Y吻合296例。术后并发症有胆漏15例（2.9%）、膈下感染23例(4.5%)、腹腔脓肿2例（0.4%）和肝衰3例（0.6%）等。11例（2.1%）术后死于肝衰竭。随访10个月到25年，75.9%症状消失，14.5%偶而有轻度胆管炎发作，9.6%仍反复发作严重胆道感染。49例手术效果差的主要原因是肝脏切除范围不够兖分而遗留病变的肝胆管。结论 规则性肝叶切除术是清除病灶的最有效手段。     

腹腔镜辅助左肝外叶切除治疗肝内外胆管结石15例分析

本文对我院自2006年5月至2010年5月以左肝内外胆管结石行腹腔镜辅助左肝外叶切除15例,与同期21例行开腹手术的临床资料相比较,探讨腹腔镜辅助左肝外叶切除治疗左肝内胆管结石的临床价值。报告如下。1资料与方法1.1一般资料选取我院2006年5月至2010年5月经B超及CT或磁共振胆胰管成像(MRCP)检查明确诊断并经手术治疗的肝内外胆管结石病人。     

肝段联合切除治疗肝内胆管结石及狭窄

目的 探讨肝内胆管结石合并肝内胆管狭窄的手术治疗措施。方法 1994年1月至2002年1月共施行肝段切除治疗肝内胆管结石病人338例。Ⅱ、Ⅲ段联合切除284例，Ⅱ、Ⅲ、Ⅳ段联合切除8例，Ⅴ、Ⅵ段联合切除14例，Ⅵ、Ⅶ段联合切除9例，Ⅱ、Ⅲ、Ⅴ、Ⅵ段联合切除6例，Ⅱ、Ⅲ、Ⅵ、Ⅶ段联合切除5例，Ⅳb段切除12例。结果 本组中3例手术后死亡。28例存在肝内胆管的残余结石，残余结石发生率为8．28％。手术结合纤维胆道镜取石，取净率为97．93％。结论 联合肝段切除为治疗肝内胆管结石并狭窄的有效措施，手术结合术后纤维胆道镜取石能明显提高肝内胆管结百并狭窄的治愈率。     

Is Hepatectomy Necessary in Dealing with Left Hepatolithiasis with Intrahepatic Duct Stricture?

Background: Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture.Methods: In this prospective clinical trial 13 patients with retained left hepatolithiasis and intrahepatic biliary strictures were included. All the patients met the following criteria: (1) initial surgical procedure for hepatolithiasis, (2) normal gross findings of the left liver, and (3) no obvious clinical evidence of an associated intrahepatic cholangiocarcinoma. After the operation they underwent matured T-tube tract ductal dilatation with percutaneous transhepatic cholangioscopy tube stenting. Choledoschoscopic electrohydraulic lithotripsy was used in five patients after dilatation when impacted or large stones were encountered.Results: Complete clearance of the stones was achieved in these 13 patients. One patient had fevers develop after ductal dilatation, and another patient had mild hemobilia after electrohydraulic lithotripsy. Both recovered uneventfully with conservative treatment. These successfully treated patients remain well, with a mean follow-up period of 20 months.Conclusions: Postoperative matured T-tube tract ductal dilatation and stenting, combined with endoscopic electrohydraulic lithotripsy when indicated, is an effective and safe alternative to hepatic resection for selected left hepatolithiasis with intrahepatic biliary stricture.     

Laparoscopic right hemihepatectomy for hepatolithiasis

Background Liver resection is the definitive treatment for unilateral hepatolithiasis [1]. Recently, laparoscopic major hepatectomias have become more common and are being performed in highly specialized centers [2–4]. However, few laparoscopic liver resections for hepatolithiasis have been reported. Chen et al. [5] reported two cases of laparoscopic left lobectomy for hepatolithiasis, but to our knowledge, right hepatectomy has never been reported to date. This video demonstrates technical aspects of a totally laparoscopic right hepatectomy in a patient with hepatolithiasis. Methods A 21-year-old woman with right-sided nonoriental primary intrahepatic stones [1] was referred for surgical treatment. The operation followed four distinct phases: liver mobilization, dissection of the right portal vein and right hepatic artery, extrahepatic dissection of the right hepatic vein, and parenchymal transection with harmonic shears and linear staplers for division of segment 5 and 8 branches of the middle hepatic vein. No Pringles’ maneuver was used. In contrast to liver resection for other indications, the right bile duct was enlarged and filled with stones. It was divided during parenchymal transection and left open. After removal of the surgical specimen, the biliary tree was flushed with saline until stone clearance, under radioscopic surveillance, was complete. The right hepatic duct then was closed with running suture. Results The operative time was 240 min, and the estimated blood loss was 120 ml, with no blood transfusion. The hospital stay was 5 days. At this writing, the patient is well and asymptomatic 7 months after the procedure. Conclusion Laparoscopic liver resection is safe and feasible for patients with hepatolithiasis and should be considered for those suffering from intrahepatic stones. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Hepatectomy in intrahepatic lithiasis

STUDY AIM: The aim of this study was to report the immediate results of a series of 65 hepatic resections for hepatolithiasis performed in Vietnam. PATIENTS AND METHOD: From 1986 to 1998, 44 men and 21 women (mean age: 40 years) underwent hepatic resection for hepatolithiasis. Fourty patients had previously undergone one or several operations for hepatolithiasis. The procedure was performed on emergency in 25 patients. Indications for hepatic resection were: angiocholitis and liver abscess in 22 cases, stones closely inserted in the biliary duct in 20 cases, hemobilia in 12 cases, stones located above a biliary stricture in 8 cases and stones associated with a postoperative biliary fistula in 3 cases. Liver resections (minor in 61 patients, including 55 left lobectomies, and major in 4 patients) were performed through transhepatic approach according to the Ton That Tung technique and followed by an external biliary drainage with a Kehr tube. RESULTS: There were 6 postoperative deaths (9%), 3 due to septic shock, 2 to cachexia, and 1 to liver failure. The 15 patients with complications recovered with conservative therapy. Bile infection was present in 93%, mostly with Escherichia coli and Enterobacter. Pigmented stones were usually found. CONCLUSION: Vietnam is a country with high incidence of hepatolithlasis. Hepatic resection is an adequate treatment for localized intrahepatic bile duct stones when the involved segment including biliary strictures and calculi can be completely removed. The procedure may be performed on emergency for liver abscess, or hemobilia.     

Comparison of treatments for hepatolithiasis: hepatic resection versus cholangioscopic lithotomy.

BACKGROUND: Hepatic resection and percutaneous transhepatic cholangioscopic lithotomy (PTCSL) are the two main approaches to the treatment of hepatolithiasis, but comparisons of longterm followup results have not been adequately reported. STUDY DESIGN: Of 86 patients with hepatolithiasis admitted to our institution between 1980 and 1996, we reviewed 54 patients: 26 who underwent hepatic resection and 28 who underwent PTCSL. Five patients who underwent postoperative cholangioscopic lithotomy were included in the former group. The remainder of the hepatolithiasis patients were not treated by hepatic resection or PTCSL and, therefore, were excluded from this study. Hepatic resections were mainly indicated for left-sided localized intrahepatic calculi, atrophic liver, and possible presence of cholangiocellular carcinoma. PTCSL was performed for right-sided, bilateral or recurrent stones at an average of 6 treatments (range 1 to 20 treatments) for each patient. There were no differences between the two groups in terms of gender or age. The recurrence rate of stones and longterm prognosis were analyzed using the Kaplan-Meier method, and other clinical factors listed below were statistically compared. RESULTS: The rate of complete removal of stones was similarly high in each group (96.2% in the hepatic resection group versus 96.4% in the PTCSL group). The complication (38.5% versus 21.4%) and 5-year survival (85.6% versus 100%) rates were comparable. Remaining bile duct stricture (18.2% versus 60.9%, p < 0.01) and 5-year recurrence rates (5.6% versus 31.5%, p < 0.05) were statistically lower in the hepatic resection group than in the PTCSL group. CONCLUSIONS: Hepatic resection, when combined with postoperative cholangioscopic lithotomy, is a preferable treatment for left-sided stones with strictures and bilateral stones.     

Hepatolithiasis in the hepatic hilum mimicking hilar cholangiocarcinoma: Report of a case

We report a rare case of hepatolithiasis, which was diagnosed as hilar cholangiocarcinoma and treated with hepatectomy and extrahepatic bile duct resection. A 59-year-old woman presented to a local hospital with liver dysfunction. Diagnostic imaging revealed a biliary stricture at the hepatic hilum and middle bile duct. Hilar cholangiocarcinoma was diagnosed, and she was referred to our hospital for definitive surgical treatment. She underwent left hepatic trisectionectomy, total caudate lobectomy, and extrahepatic bile duct resection. Gross examination of the resected specimen revealed intrahepatic stones firmly adherent to the bile duct wall. Pathological examination revealed no malignant lesions. The epithelium of the bile duct was absent underneath the stone, and the boundary between the stone and bile duct wall was ill defined. To our knowledge, this is the first case report of hepatolithiasis with a biliary stricture caused by peculiar stone formation, mimicking hilar cholangiocarcinoma.     

肝内胆管结石并肝内胆管癌

目的　探讨肝内胆管结石并肝内胆管癌 (HLAIHCC )的病因、诊断、治疗和预防。方法　分析两家医院 1986年 3月～ 1997年 6月 6例HLAIHCC的临床资料。结果　HLAI HCC主要临床表现是夏科氏三联症 ;胆管癌发生处都有结石。病理检查均为腺癌。 5例于 1年内死亡。结论　肝内胆管癌与肝内胆管结石所引起的刺激、炎症、感染有一定关系 ,早期切除含结石的肝组织 ,可减少肝内胆管癌的发生。     

Liver resection for intrahepatic stones

HYPOTHESIS: Long-term outcome is good for a selected group of patients with hepatolithiasis treated with liver resection. Liver resection should also be offered to patients with complex hepatolithiasis such as bilateral stones or those with strictures. DESIGN: Retrospective study. SETTING: Regional hospital. PATIENTS: A total of 174 patients with hepatolithiasis (201 procedures) treated between January 1, 1989, and September 30, 2003. INTERVENTIONS: Liver resection (52 procedures) or removal of stones primarily by percutaneous choledochoscopy (149 procedures). MAIN OUTCOME MEASURE: Recurrence of cholangitis. RESULTS: Most patients in the liver resection group had stones localized to the left side. The overall success rate in this group was 98.0% (49 of 50 patients, excluding 2 patients found to have cholangiocarcinoma). The chance of biliary sepsis at 5 years after resection was 13.3%. The overall success rate of stone removal primarily by percutaneous choledochoscopy was 70.5%. The bilaterality of stones, the presence of stricture, and the presence of atrophy were found to be significant risk factors for a poor long-term outcome after stone removal alone. The chance of biliary sepsis at 5 years was 26.4% and 43.2% for those without and with stricture, respectively. CONCLUSIONS: The long-term outcome after liver resection for hepatolithiasis was excellent for a selected group of patients. Poor outcomes were recorded for patients whose intrahepatic stones were removed primarily by percutaneous choledochoscopy, especially those with strictures. The indication for liver resection for hepatolithiasis should be extended to patients with strictures and those with bilateral stones. A combination of different treatment modalities is necessary to improve the outcome of these patients.     

The role of endoscopic lithotomy in the treatment of intrahepatic stones

Although hepatolithiasis is a benign disease, its treatment is still the most difficult one in medical field. Before 1977, we had tried bilioenterostomy at the porta hepatis to expect spontaneous dislodgement of stones. However their results were very poor because of frequent occurrence of cholangitis which leads to hepatic failure or death in 8 of 15 patients. From 1977 to 1981, 35 patients had undergone postoperative cholangioscopy (POC). Complete stone removal was obtained in 24 patients. There were 13 difficult local problems in the remaining 11 patients including 6 being too narrow to permit the passage of the fiberscope, 3 having stones incarcerated, 3 having abnormal distribution of biliary tract and one being a missed stone. From 1981, we have carried out percutaneous transhepatic cholangioscopic lithotomy (PTCL) for the treatment of intrahepatic stones in 16 patients. Because abnormal distribution of biliary tract can be easily detected by PTC and incarcerated stones can be made into small pieces before removal following LASER application. We had succeeded in complete stone removal in 12 patients. 2 patients needed biliary reconstruction or liver resection after PTCL. We concluded that for treatment of the disease of intrahepatic stone PTCL should be considered as the first choice before surgery in order to avoid unnecessary hepatic resection or biliary reconstruction.     

Treatment of Complicated Hepatolithiasis with Intrahepatic Biliary Stricture by Ductal Dilatation and Stenting: Long-term Results

A group of 190 cases of hepatolithiasis with postoperative residual stones located proximal to the stricture sites were managed with the aim of complete clearance of stones and relief of bile stasis to decrease the potential risk of recurrence. All procedures were performed through a T-tube track with gradual dilatation and stent placement through the stricture sites, creating a channel that allows cholangioscopy and electrohydraulic lithotripsy. Complete clearance of intrahepatic duct (IHD) stones was achieved in 88.4% of cases. Multiple sharply angulated IHD strictures in right-sided hepatolithiasis constituted a major cause of failure. Recurrent stone formation and repeated cholangitis, subsequent drainage, and liver resection are associated with high mortality rates particularly if there is late development of a cholangiocarcinoma. We concluded that postoperative ductal dilatation and stenting through the T-tube track combined with endoscopic electrohydraulic lithotripsy is effective and safe for managing complicated hepatolithiasis. Persistent irreversible aneurysmal dilatation of IHD and atrophic change of the affected hepatic lobe at follow-up were ominous signs of recurrence and cholangiocarcinoma development. Early drainage with stone extraction combined with surgical intervention can prevent subsequent morbidity and mortality.