肝段及半肝切除治疗肝内胆管结石的临床分析  

Clinical analysis of segmentectomy and hemihepatectomy for treatment of hepatolithiasis

作　　者：胡自苗[1] 胡友勉 黄文峰[1] 文新元[1] 易勤根 肖本萍 谈定武 

机构地区：[1]萍乡市人民医院普外科,江西省337055

出　　处：《中华肝胆外科杂志》2007年第7期457-459,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的对肝内胆管结石应用肝段及半肝切除术进行临床疗效分析。方法总结1993年11月至2006年3月应用肝段及半肝切除治疗63例肝内胆管结石的临床经验、方法及疗效。结果根据肝内结石的分布范围决定肝段及半肝切除的范围。手术后疗效优良者47例，优良率92％。结石复发4例，占7．8％。结论肝段及半肝切除是清除结石等病灶的最有效方法；对右侧及双侧肝内胆管结石行肝段或半肝联合切除，为复杂肝内胆管结石的治疗拓展了治疗范围；提高左半肝的切除比例，能避免单纯行2、3段切除遗漏第4段结石的发生，降低残石率；同时联合应用其它手术方式能明显提高远期疗效。Objective To investigate the efficacy of segmentectomy and hemihepatectomy for treatment of lntrahepatic biliary calculi. Methods The clinical data of 63 patients with lntrahepatic biliary calculi treated with segmentectomy and hemihepatectomy in our hospital from November 1993 to March 2006 were retrospectively analyzed to summarize the clinical experience, methods and therapeutic efficacy. Results The ranges of the segmentum hepatecomy and hemihepatectomy were determined according to the distribution of intrahepatic calculus. Amongst the 63 patients, 30 received the hepatectomy of the 2nd and 3rd segment （the left lateral segment）, 25 the left hemihepatectomy, 1 the hepatectomy of the 6th segment and the left hemihepar, 1 case for the right hemihepatectomy, 1 case for the hepatectomy of the 6th and 7th segment （right rear segment）, 1 the hepatectomy of the 2nd segment and 2 the hepatectomy of the 4th segment. Meanwhile, 2 patients underwent the commissurtomy of the right hepatic duct or the common hepatic duct with the ananastomosis of the gallbladder and the intestine, 4 choledochojejunostomy. There were no serious complications and death after the operations. Residual stones were found in only 10 of the 63 patients postoperatively. The follow-up was conducted in 53 patients for 3 months to 13 years. Excellent outcome was found in 47 patients （92%） and recurrence was seen in 4 （7.8%）. Conclusion Segmentectomy and hemihepatectomy are effective for treatment of intrahepatic biliary calculi. The segmentum hepatectony and the hemihepatectomy conducted for the right and both lobes of calculus of intrahepatic duct can expand the operative scope for the treatment of complicated intrahepatic lithiasis. Promoting the rate of hemihepatecotomy can avoid resecting only the 2nd and 3rd segment and remaining stones in 4th segment as well as decreasing the rate of residual stones. Meanwhile, other surgical methods can be integrated with the segmentum hepatectomy and the hemihepatectomy to promote the long-ter

关 键 词：胆结石 肝内胆管 肝切除术 

分 类 号：R686[医药卫生—骨科学]