肝切除术治疗肝内胆管结石98例临床分析  

Hepatectomy for hepatolithiasis： an analysis of 98 cases

作　　者：赵海涛[1] 刘立国[2] 缪若羽[1] 卢欣[1] 徐意瑶[1] 杜顺达[1] 徐海峰[1] 迟天毅[1] 杨华瑜[1] 杨志英[1] 毛一雷[1] 桑新亭[1] 钟守先[1] 黄洁夫[1] 

机构地区：[1]中国医学科学院北京协和医院肝脏外科,100730 [2]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所腹部外科

出　　处：《中华普通外科杂志》2010年第3期217-220,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（C30970623）

摘　　要：目的探索肝内胆管结石经肝切除治疗患者的疗效和预后情况。方法回顾性分析1984年4月至2009年3月北京协和医院经肝切除治疗的98例肝内胆管结石患者的临床资料。结果本组98例患者中男女比例1：1．7，中位年龄55岁。58例（59．2％）既往接受过治疗，其中手术治疗50例。单纯左肝结石88例（89．8％），单纯右肝结石2例（2．0％），左右均受累8例（8．2％）；51例（52．0％）合并肝外胆道结石，30例（30．6％）合并胆道狭窄，28例（28．6％）有既往胆道蛔虫病病史，5例（5．1％）合并胆道恶性肿瘤。全部病例均根据结石部位行肝脏部分切除术，8例双侧受累者，行左半肝切除、右肝管取石术。术后出现并发症14例（14．3％），围手术期死亡2例（2．0％）。随访超过1年且未合并肿瘤者78例（79．6％），疗效优良率为91．0％，结石残存率和复发率均为2．0％。结论肝切除术治疗既能清除结石，又能切除病变的胆道，具有结石残存率低和复发率低的优点，同时能对胆道恶性肿瘤早诊早治，是治疗肝内胆管结石的重要手段。Objective To investigate the effect and long-term prognosis of patients who underwent hepatectomy for hepatolithiasis. Methods We retrospectively analyzed the medical records of 98 patients with hepatolithiasis who were treated by hepatectomy in Peking Union Medical College Hospital. Results Male/female： 1/1.7; median age： 55 years old. 58 cases （59.2%） bad been treated before; among them, 50 by surgery. In 88 cases （89. 8% ） hepatolithiasis involved the left lobe only, in 2 （2.0%） only the right lobe involved, and in 8 （8. 2% ） both left and right lobe were involved. 51 （52. 0% ） had extrahepatic biliary stones, 30 （30. 6% ） had biliary duct strictures, 28 （28.6%） had a history of biliary ascariasis, and 5 （ 5.1% ） had a concurrent biliary tract malignancy. All received partial hepatectomy according to the stone location; for the 8 bilaterally involved patients, left hepatectomy and right lithotomy were performed. Postoperative complications occurred in 14 cases （ 14. 3% ）, and there were 2 perioperative deaths （2. 0% ）. Seventy-eight patients （79. 6% ） have been followed up for over I year with no tumors; the results were excellent or good in 91.0%; the stone residue and recurrence rate were both 2.0%. Conclusions Hepatectomy not only eliminates calcnci, but also removes diseased biliary tracts, with advantages of low residue stone and recurrence rate.

关 键 词：胆结石 肝切除术 

分 类 号：R657.4[医药卫生—外科学]