肝叶切除术在肝内胆管结石中的应用  

Application of hepatic resection in hepatolithiasis

作　　者：孟元普[1] 柴新群[1] 储鸿鹏 杨轩[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,湖北省武汉市430022

出　　处：《世界华人消化杂志》2014年第32期5001-5004,共4页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81070059~~

摘　　要：目的:探讨肝叶切除术(hepatic resection,HR)在肝内胆管结石(hepatolithiasis,HL)中的治疗价值.方法:回顾性分析华中科技大学同济医学院附属协和医院肝胆外科2005-06/2014-05共实施HR的130例HL病历资料.结果:肝左外叶切除术87例;左半肝切除19例;肝方叶切除9例;规则性肝段切除8例;肝右叶部分切除及肝左外叶切除3例;右半肝及肝左外叶切除1例;左内叶切除3例;结石清除率为87%;发现胆管癌15例;术后结石残留13例.术后主要并发症:切口感染、胆漏、肺部感染、胸腔积液.并发肝功能衰竭死亡1例.结论:HR是治疗HL的一种安全、有效的治疗方法,充分的术前评估、合理的手术方案能够减少或避免胆道再次手术.AIM： To investigate the value of hepatic resec- tion in the treatment of hepatolithiasis. METHODS： The clinical data for 130 patients with hepatolithiasis who underwent hepatecto- my from June 2005 to May 2014 were retrospec- tively analyzed. RESULTS： Left lateral hepatic lobectomy was per- formed in 87 patients, left hepatectomy in 19 pa- tients, quadrate lobe resection in 9 patients, regular hepatic resection in 8 patients, partial right lobe resection with left lateral lobectomy in 3 patients, right hepatectomy with left lateral lobectomy in 1 patient, and left medial hepatic resection in 3 patients. The stone clearance rate was 87%. Fifteenpatients were discovered to have cholangiocarci- noma, and 13 cases had residual stones. Postopera- tive complications included incision infection, bile leakage, pneumonia, and pleural effusion. One patient died of liver failure preoperatively. CONCLUSION： Hepatectomy is a safe and ef- fective treatment for hepatolithiasis. Adequate preoperative evaluation and reasonable surgical procedure can help reduce or avoid biliary tract reoperation.

关 键 词：肝内胆管结石 肝叶切除术 胆道再次手术 

分 类 号：R657.3[医药卫生—外科学]