精准肝切除术治疗复杂性肝胆管结石：附60例报告

目的：探讨精准肝切除术对于治疗复杂性肝胆管结石的临床效果。方法：回顾性分析近2年间接受精准肝切除术治疗的60例复杂性肝胆管结石患者的临床资料。结果：全组患者手术均顺利完成，平均手术时间为（358.60±45.6）min，术中出血量为（598.2±95.6）mL，术后住院时间为（12.5±2.7）d。术后发生并发症11例（18.3%），其中切口感染5例（8.3%），胆瘘1例（1.7%），右侧胸腔积液3例（5.0%），肺部感染2例（3.3%）。术后随访2个月至2年，残留结石3例（5.0%），经T管纤维胆道镜取净结石；2例（3.3%）复发，再次行内镜下十二指肠乳头括约肌切开术（EST）（再次手术率3.3%）取净结石。结论：精准肝切除术可有效降低残石率、复发率和再次手术率，是治疗复杂性肝胆管结石的有效方法。

Precise hepatectomy for complicated hepatolithiasis: a report of 60 cases

Objective: To investigate the clinical efficacy of precise hepatectomy for complicated hepatolithiasis. Methods: The clinical data of 60 patients with complicated hepatolithiasis undergoing precise hepatectomy within the last two years were retrospectively analyzed. Results: The operations were performed successfully in all patients. The average operative time was (358.60±45.6) min, intraoperative blood loss was (598.2±95.6) mL and length of postoperative hospital stay was (12.5±2.7) d. Postoperative complications occurred in 11 cases (18.3%) and included 5 cases (8.3%) of wound infection, 1 case (1.7%) of bile leakage, 3 cases (5.0%) of right pleural effusion, and 2 cases (3.3%) of lung infection. During the follow-up period of 2 months to 2 years, residual stones were found in 3 patients (5.0%), which were removed by choledochofiberscope through T-tube sinus tract, and recurrence occurred in 2 patients (3.3%) who were treated again by endoscpic sphincterotomy (EST) to extract stones. Conclusion: Precise hepatectomy is effective for treatment of complicated hepatolithiasis, which can reduce the rate of residual and recurrent stones and reoperation.