经肝断面胆道探查取石治疗左肝内胆管结石合并胆总管结石的临床应用

目的评估经肝断面胆道探查替代胆总管切开胆道探查术治疗左肝内胆管结石合并胆总管结石的可行性及效果。方法 回顾性分析笔者所在医院科室收治的122例左肝内胆管结石合并胆总管结石患者的临床资料，其中2007年6月至2010年6月期间的64例患者行左肝切除、胆总管切开取石、T管引流术（对照组），2011年6月至2013年12月期间的58例患者行左肝切除联合术中经肝断面残端胆管行胆道探查取石术（观察组），比较2组患者的手术时间、术中出血量、术后住院时间及并发症发生率。结果与对照组相比，观察组患者术后住院时间明显缩短（P〈0．05），2组的手术时间及术中出血量的差异无统计学意义（P〉0．05），观察组术后并发症发生率明显低于对照组（P〈0．05）。122例患者中105例获随访，随访率为86．1％，随访期为2年，2组患者均无结石残留及复发。结论术中通过肝断面途径胆道探查是治疗左肝内胆管结石一种有效的方法，简化了操作程序，缩短了住院时间，有效避免胆总管切开和T管引流所带来的并发症。

Clinical Application on Hepatectomy Combined with Biliary Tract Exploration via The Bile Duct Stump in Treatment of Hepatolithus

Objective To evaluate the feasibility and effect of treatment of bile duct exploration though hepatic sections instead of spliting common bile duct, cured for hepatolithiasis with bile duct stones. Methods Clinical data of 122 cases of our hospital were retrospectively reviewed, these patients with left intrahepatic bile duct stone and common bile duct calculi. As control group, during the period from June 2007 to June 2010, in which 64 patients underwent left hepatic lobectomy, common bile duct exploration and T tube drainage. In observation group, 58 patients from June 2011 to December 2013, underwent left hepatic resection combined biliary duct exploration by the liver section stump bile duct. The operative time, intraoperative bleeding volume, postoperative hospitalization time, and incidence of complica- tions between the 2 groups were compared. Results Compared with the control group, the postoperative hospitalization time was shortened obviously in observation group patients （P〈0. 05）, there were no significant difference in operative time and bleeding during operation of 2 groups （P〉0. 05）, The incidence of postoperative complications in the observa- tion group was significantly lower than the control group （P〈 0.05）. In 122 patients, 105 cases were followed-up （86. 1%）, the follow-up time was 2 years. Two groups of patients had no stone residual and recurrence. Conclusions Bile duct exploration by intraoperative liver section is an effective method to treat left hepatolithiasis, it can simplified procedures, shortening the postoperative hospitalization time, and effectively avoid complications caused by common bile duct inci-sion and T tubedrainage.