肝切除治疗肝胆管结石的临床应用  

HEPATECTOMY FOR THE TREATMENTOF HEPATOLITHIASIS IN 75 CASES

作　　者：虞长春[1] 程铮[1] 余结水 汪学华[1] 江树国 

机构地区：[1]安徽省望江县医院,望江246200

出　　处：《肝胆外科杂志》2009年第4期292-294,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝叶切除术治疗肝胆管结石的疗效。方法回顾性分析1996年1月至2008年7月间75例采用肝叶切除治疗肝胆管结石患者的临床与随访资料。结果左外叶(Ⅱ、Ⅲ)切除50例,左半肝(Ⅱ、Ⅲ、段)切除15例,右半肝(Ⅴ、Ⅵ、Ⅶ、Ⅷ)及右后叶(Ⅵ、Ⅶ段)切除各3例,右前叶(Ⅴ、Ⅷ段)、右后叶加左外叶(Ⅱ、Ⅲ、Ⅵ、Ⅶ)、肝Ⅲ、Ⅵ、Ⅷ段切除及肝Ⅲ、Ⅴ段切除各1例。同时行胆总管T管外引流63例,行胆肠内引流手术12例。围手术期无死亡病例。术后残余肝胆管结石9例,肝外胆管结石复发7例。72例随访9月至158月,平均75个月。疗效优76.4%(55/72),良16.7%(12/72),差2例,近期死亡4例(分别死于肝胆管癌、胆囊癌、胰腺癌、结肠癌)。结论肝叶切除是治疗肝内胆管结石的有效手段,要严格掌握胆肠内引流手术适应症。Objective To investigate the efficiency of hepatectomy for hepatolithiasis. Methods The efficiency and patterns of operation were retrospectively analysed on 75 cases of hepatolithiasis from January, 1996 to July, 2008. Result 50 patients were operated on left externallobe （ S Ⅱ Ⅲ, ） ; left semi-hepatectomy （ S Ⅱ Ⅲ, Ⅳ ） for 15 patients, right semi-hepatectomy （ s Ⅴ, Ⅵ,Ⅶ,Ⅷ ） for 3 patients and right posterior lobe （ Ⅵ, Ⅶ ） for 3 patients. Additional external drainage for common bile duct were done on 63 cases and additional biliary internal drainage for duct-intestine on 12 cases. No one was died in perioperative period. 72 patients were followed up from 9 to 158 months and the curate effect of excellent in 55 patients; good in 12 patients, bad in 2 case. Conclusion Hepatectomy is theeffective treatment for the most of hepatolithiasis and it is strict to adopt biliary internal drainage.

关 键 词：肝内胆管结石 肝切除 

分 类 号：R657.5[医药卫生—外科学]