循纤维化边界行解剖性肝切除在肝胆管结石并肝萎缩肥大征治疗中的应用  

Fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex

作　　者：孙增鹏[1] 谭志国 彭创[1] 易为民[1] 杨平洲[1] 厉鸥[1] Sun Zengpeng;Tan Zhiguo;Peng Chuang;Yi Weimin;Yang Pingzhou;Li Ou(Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)肝胆外科,湖南省胆道疾病防治临床医疗技术研究中心,长沙410005

出　　处：《中华普通外科杂志》2021年第7期499-502,共4页Chinese Journal of General Surgery

基　　金：湖南省卫计委科研基金(20200179);湖南省教育厅科研基金项目(20C1163);湘卫医政医管处便函((2019)118号)。

摘　　要：目的探讨循肝纤维化边界行解剖性肝切除在肝胆管结石并肝萎缩肥大征治疗中的应用价值。方法回顾性分析2011年1月至2019年12月湖南省人民医院肝胆外科循肝纤维化边界行解剖性肝切除治疗的167例肝胆管结石并肝萎缩肥大征患者的临床资料。结果本组患者均在肝纤维化边界引导下成功进行解剖性肝切除,配合术中胆道镜取石,平均历时(231.5±37.1)min,平均失血量(375.7±52.6)ml。术后平均住院时间为(10.2±1.1)d,残石率8.9%,按照Clavien-Dindo评分系统,Ⅰ级并发症86例,Ⅱ级并发症35例,无Ⅲ级以上并发症。167例患者术后经过3~107个月的门诊随访,15例复发结石,其中4例行再次手术治疗。结论循纤维化边界行解剖性肝切除治疗肝胆管结石并肝萎缩肥大征是安全有效的。Objective To evaluate fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex.Methods One hundred and sixty-seven cases undergoing hepatectomy guided by the boundary of liver fibrosis in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex from Jan 2011 to Dec 2019 in Hunan Province Peopole's Hospital were reviewed.Results All patients were successfully treated by anatomical hepatectomy under the guidance of the liver fibrosis boundary with intraoperative choledochoscopy,the operation time was(231.5±37.1)min and the average blood loss was(375.7±52.6)ml,the average hospital stay was(10.2±1.1)days,the residual stone rate was 8.9%,according to the scoring system of Clavien-Dindo,Grade Ⅰ complications occured in 86 cases,Grade Ⅱ complications occured in 35.Follow-up ranged from 3 to 107 months,15 cases had recurrent stones,four were reoperated.Conclusions Fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex is safe and effective.

关 键 词：胆结石 胆管 肝切除术 萎缩肥大征 

分 类 号：R657.3[医药卫生—外科学]