规则性肝段切除结合胆道镜治疗肝内胆管结石

目的 研究规则性肝段切除结合胆道镜治疗肝内胆管结石的优越性及有效性。方法 根据289例患者肝内胆管结石的分布情况(左外叶138例．左肝叶96例，右前叶6例，右后叶12例，右肝叶25例。双侧肝叶12例；合并有显著肝段或肝叶萎缩98例，肝脓肿8例，胆瘘3例，胆管癌5例)行肝段或联合肝段切除。其中S2～S3切除181例，S2～4切除56例．S6～S7切除18例，S5～8切除12例，双侧肝叶切除12例。附加术式包括经肝门部胆管切开取石186例，经肝实质胆管切开取石8例，胆管空肠Roux-en-Y吻合196例(10例输出空肠拌皮下埋植)。术中胆道镜经胆总管途径186例，肝断面胆管途径103例，术后胆道镜经T管途径186例，皮下输出空肠袢途径10例。结果 随访10个月至10年，89．5％(259／289)症状消失，7．9％(23／289)偶有轻度胆管炎发作，2．6％(7／289)仍反复发作严重胆道感染。术后并发症有胆漏8例(2．8％)．膈下感染12例(4．2％)．腹腔脓肿1例(0．35％)．3例(1．03％)术后死于肝衰竭。结论 规则性肝段切除术结合胆道镜技术是治疗肝内胆管结石的最有效手段。

ANATOMIC HEPATECTOMY AND CHOLEDOCHOSCOPE FOR THE TREATMENT OF HEPATOLITHIASIS

Objective To study the superiority and efficiency of regular hepatic resection and choledochoscope for hepatolithiasis.Methods Two hundred and eight-nine patients with hepatolithiasis(include stones from repeated episodes of obstruction and infection ,mutiple strictures of the duct in the affected portion of the liver.)underwent hepatic resection and choledochoscope.Resection of S2 and S3 was preformed in 181 patients,S2,S3 and S4 in56 patients,S6 and S7 in 18 patients,S5,S6,S7 and S8 in 12 patients;both of the left and right hepatic lobes were partially resected in12 patients. Additional biliary procedures including choledochojejunostomy and common bile duct exploration were preformed. Intraoperative and postoperative choledochoscopy were preformed in 289 patients.Result Long-term follow up on 286 patients at a median of 4.8 years showed that 89.5% were symptom free,7.9% had occasional mild attacks of cholangitis, 2.6% had severe cholangitis requiring further surgical intervention. The operative mortality was 1.03%, morbidity rate was 8.4%. The major of complications were biliary fistula (2.8%), subphrenic infection (4.2%), peritoneal abscesses(0.35%) and liver failure(1.03%). Conclusion Anatomic hepatic resection and choledochoscope is the most effective treatment and the therapy of choice to eradicate intrahepatic stone foci in case of hepatolithiasis.