右叶肝胆管结石的临床病理类型

目的 探讨右侧肝胆管结石的分布类型.为外科治疗提供依据.方法 报告1998-2005年第三军医大学西南医院全军肝胆外科研究所收治并接受手术的右侧肝胆管结石106例的结石分布情况.结果 右半肝型25例占23.8%,右半肝合并左叶型33例占31.1%,右后叶型15例占14.1%,右后叶合并左叶型9例占8.5%,右前叶型4例占4.8%,右前叶合并左叶型6例占5.7%,右后叶下段型3例占2.8%.右后叶下段合并左叶型6例占5.7%,右半肝型加上合并左叶型数量明显多于右后叶或右前叶型合并左叶型(P<0.01),右半肝型与右半肝合并左叶型或右后叶型比较无统计学差别(P>0.05).结论 右半肝型和右半肝合并左叶型构成右侧肝胆管结石50%以上,右半肝型右后叶型加上合并左叶型构成右侧肝胆管结石的绝大多数,右半肝切除、右后叶切除联合左侧肝管取石是最常用的手术类型,此种结石分布类型同右肝管解剖与肝门的病理改变相关.

Clinicopathological type of right lobular hepatolithiasis

Objective To explore the distribution type of hepatolithiasis on right side and to provide foundation for surgical treatment. Methods One hundred and six patients suffering from hep-atolithiasis in right lobe underwent surgical treatment about distribution of stone during 1998-2005has been reported. Results The location of stones was the right hemihepatic type in 25 patients (23.8%), right hemihepatic associated with left lobe type in 33 (31.1%), right latter lobe type in 15(14.1%), right latter lobe with left lobe type in 9 (8.5%), right front lobe type in 4 (2.8%), right front lobe with left lobe type in 6 (5.7%), right latter inferior segment type in 3 (2.8%), right latter inferior with left lobe type in 6 (5.7%). The number of right hemihepatic type added with left lobe type was more than that of the right right latter lobe or right front lobe type added with left type (P<0.01). There was no significant difference between the number of right hemihepatic type and that of the right hemihepatic with left lobe type or right latter lobe type (P>0.05). Conclusion The number of right hemihepatic type and right hemihepatic with left lobe type accounts for over 50% of right side hepatolithiasis about distribution type of stone. The right hemihepatic type and right latter lobe type added with left lobe type constitute the majority of distribution type of stone for right side hepatolithia-sis. The right hemihepatectomy and right latter lobectomy unite transcholedoscopy to draw stones from left side hepatic duct is the most common surgical operative pattern. This distribution type of stone has association with the anatomy of right hepatic duct and pathology of porta hepatic.