左肝外叶胆管结石的肝叶切除范围探讨  

Hepatectomy for left lateral lobe hepatolithiasis

作　　者：张维建[1] 蒋飞照[1] 方瑶[2] 朱恒梁[1] 

机构地区：[1]温州医科大学附属第一医院腔镜外科,浙江省325000 [2]温州医科大学附属第一医院急诊科

出　　处：《中华普通外科杂志》2015年第11期882-884,共3页Chinese Journal of General Surgery

摘　　要：目的探讨左肝外叶胆管结石的肝叶切除范围。方法回顾性分析110例肝叶切除治疗左肝外叶胆管结石的临床资料，其中42例行单纯左肝外叶切除作为标准组，68例行左肝外叶加部分内叶切除或左半肝切除作为扩大组。结果2组均顺利完成手术，无围手术期死亡病例，标准组和扩大组在手术时间[（82±23）min比（98±37）min]、术中出血量[（450±270）ml比（610±280）m1]、肝断面胆漏发生率（16．7％比16．2％）、肝断面积液发生率（4．8％比8．8％）、肝断面出血量[（120±75）ml比（230±110）m1]、肝断面引流管留置时间[（6．3±2．6）d比（6．8±3．1）d]、术后3dAIJT差值[（182±98）U／L比（212±107）U／L]、术后3d胆红素差值[（21±7）mol／L比（18±6）mol／L]、术后3dPT差值[（1．0±0．6）s比（0．910．5）s]和术后住院时间[（7．8±1．9）d比（8．612．1）d1比较差异均无统计学意义（均P〉0．05）。标准组左肝内叶胆管结石残留和复发率分别为14．3％和11．9％．扩大组无结石残留和复发，2组差异有统计学意义（P〈0．05）。结论局限于左肝外叶的肝内胆管结石，左肝外叶切除加部分内叶切除或左半肝切除是安全有效的。Objective To evaluate extended vs standard left lateral lobectomy for left lateral lobe hepatolithiasis. Methods A retrospective study was conducted on the clinical data of 110 patients who underwent hepatectomy for hepatolithiasis limited to left lateral lobe of the liver. Results 42 patients received left lateral lobectomy, 68 patients did left hemihepatectomy. There were no marked difference between the two groups in the operation time, introperation or postoperation blood loss, bile leak and bleeding on the hepatic cut surface, liver function and the postoperative hospital stay. The incidence of residual and recurrent stones was 14. 3% and 11.9% in left lateral lobeetimy group and 0% , 0% in left hemihepatectomy group. Conclusion Left hemihepatectomy for left lateral lobe hepatolithiasis is a safe and effective procedure.

关 键 词：胆结石 肝切除术 手术后并发症 

分 类 号：R657.4[医药卫生—外科学]