肝切除术治疗复杂性肝胆管结石(附82例报道)

目的探讨肝切除术治疗复杂性肝胆管结石的治疗效果及应用价值。方法回顾性分析我院肝胆外科2005年1月1日至2008年12月31日采用肝切除术治疗复杂肝胆管结石患者的临床资料,统计结石的分布、手术方式及疗效。结果术后并发症发生率14.6%(12/82),包括胆瘘3例,腹腔脓肿2例,腹腔出血1例,胆道出血1例,切口感染及迁延愈合5例。统计术后2~4周T管造影资料,残石率为9.8%(8/82)。60例患者获得随访,随访率73.8%(60/82),治疗效果优者占71.7%(43/60)。结石复发率13.3%(8/60),胆管炎发病率10.0%(6/60),术后胆道镜取石率6.7%(4/60),病死率0%(0/84)。结论肝切除术在治疗复杂性肝胆管结石中有着重要地位。

Clinical Application of Hepatectomy for Hepatolithiasis

Objeetive To explore the effect and value of hepatectomy in curing complicated hepatolithiasis. Methods The clinical data of 82 patients with hepatolithiasis who underwent hepatectomy from 2005-2008 were retrospectively analyzed. Stones distribution, operative modality and outcomes were examined. Results The postoperative complications occurred in 12 cases, including biliary fistula in 3 patients, peritoneal abscess in 2 patients, peritoneal hemorrhage in 1 patients, infection of incisional wound in 5 patient. Residual stones were found in 8 patients （9.8%） according to the T-tube Cholangiography. 60 cases （73.8%, 60/82） were followed-up. Residual stones were found in 8 patients （13.3%） , the rate of good long-term effect was 71.7% （4360） . The rate of AOSC was 10.0% （6/60） , the rate of operation through choledochoscope was 6.7% （4/60） , the mortality was 0% （0/60） . Conclusion Hepatectomy plays an important role in the curing of implicated hepatolithiasis.