肝切除术治疗肝内结石354例

目的探讨肝切除术治疗肝内结石的效果。方法分析１０年来采用肝切除术治疗３５４例肝内结石患者的临床表现、结石的部位和分布情况、手术方式、手术后并发症及结石残留等情况,并将１９９０年以后与１９９０年前的资料进行比较。结果肝内结石以左肝较多（３２３例）,肝切除仍以左外叶及左半肝切除为主。１３．８％的病例有结石残留;６０例出现手术后并发症;手术死亡４例。１９９０年以后再次手术的病例、术后残石率均比以前下降。治疗效果优良者占８８％。结论肝切除手术是治疗肝内结石的主要方法,为减少结石的残留和复发,应根据结石情况同时行肝内狭窄胆管切开整形、胆管空肠吻合治疗。

Hepatectomy for hepatolithiasis treatment of 354 cases

Objective To evaluate the effect of hepatectomy for hepatolithiasis. Method 354 patients with hepatolithiasis underwent hepatectomy in the past 10 years. The results were analysed retrospectively, including clinical findings, distribution of stones, patterns of operation, postoperative complications, and residual stones. The clinical data of the patients before 1990 were compared with those thereafter.Result Left hepatolithiasis was the most common form(323 patients). Left lateral lobectomy and left hepatectomy were most commonly employed(91.2%). 166 of the patients underwent concurrent cholangiojejunostomy. 13 8 % patients had residual stones, and postoperative complications occurred in 60 patients,including 4 deaths. Few patients were reoperated on and the incidence of residual stones was lower after 1990. 88 % the patients showed excellent or good result. Conclusion Hepatectomy is a procedure for the management of hepatolithiasis, but still requires combined plasty of stenotic intrahepatic bile ducts and cholangiojejunostomy to reduce the incidence of residual stones and recurrence.