| 摘要: |
| 目的：总结右半肝切除治疗肝内胆管结石的经验。方法：回顾性分析2000年1月至2006年12月采用右半肝切除治疗的39例肝内胆管结石患者的临床资料,分析术后疗效、并发症及随访情况,总结临床经验。结果：39例患者,男8例,女31例,年龄23～65岁,平均（44.2±10.5）岁；全部病例均合并不同程度的肝胆管狭窄；39例均采用右半肝切除+胆总管切开探查+T管引流术,其中28例附加胆囊切除术,1例附加左外叶切除,1例附加胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术,1例附加原胆总管十二指肠吻合口拆除；术后并发症有胸腔积液7例(17.9%)、膈下感染5例(12.8%)、肝功能衰竭3例(7.7%)、胆瘘2例(5.1%)、切口感染2例(5.1%)等；围手术期死亡2例,占5.1%；1例术后病理提示右肝内胆管癌,术后6个月死于胆管癌复发。36例(92.3%)平均随访（42.5±2.5）个月,优良率94.4%,其中单纯右侧肝内胆管结石(31例)的优良率达100%。结论：右半肝切除是治疗右肝内胆管结石的有效术式之一,尤其对于右侧肝内胆管结石伴右肝管狭窄的疗效肯定,值得推广,但因其手术难度较大,并发症相对较多,应严格把握其适应证及禁忌证。 |
| 关键词: 胆结石 肝内胆管 右半肝切除术 |
| DOI：10.3724/SP.J.1008.2008.00609 |
| 投稿时间：2008-03-04修订日期：2008-05-27 |
| 基金项目: |
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| Experience of right hemihepatectomy for treatment of hepatolithiasis in the right or both lobes |
| LU Jun-hua△,YANG Tian△,YANG Guang-shun,WU Meng-chao* |
| (Department of 2nd Biliary Tract Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University, Shanghai 200438,China) |
| Abstract: |
| Objective：To summarize our experience on right hemihepatectomy for treatment of hepatolithiasis.Methods: The clinical data of thirty-nine patients suffering from intrahepatic bile duct stones,who had undergone right hemihepatectomy in our hospital from Jan. 2000 to Dec. 2006,were retrospectively analyzed. The outcomes of operation,complication,and the follow-up findings were analyzed;and the clinical experience was summarized.Results: The 39 patients included 8 males and 31 females,with an age range of 23-65 years old and a mean of (44.2±10.5) years old.All patients had various degrees of hepatobiliary stricture.All cases underwent right hemihepatectomy plus choledochotomy and T-tube drainage,including 28 also had cholecystectomy,1 had additional left lateral hepatectomy,1 had choledochocystomy plus hepatojejunostomy,and 1 had demolishment of anastomotic stoma of choledochoduodenostomy.The post-operation complications included pleural effusion (17.9%), subphrenic infection (12.8%),liver failure (7.7%),biliary fistula (5.1%),and infection of incisional wound (5.1%).Two patients (5.1%) died of liver failure during the hospital stay.One was indicated of having intrahepatic cholangiocarcinoma and died of recurrence of cholangiocarcinoma 6 months after operation.Thirty-six patients (92.3%) received long-term follow-up (a median of \[42.5±2.5\] months) and 34 (94.4%) of them were symptom free.Excellent outcomes were achieved in the 31 patients with isolated right intrahepatic bile duct stones.Conclusion: Right hemihepatectomy is effective for right hepatolithiasis,especially for patients combined with right hepatic duct stricture.However,it should be noted that the operation is very difficult and has many complications,so the indications and contraindications of right hemihepatectomy should be strictly selected. |
| Key words: cholelithiasis intrahepatic bile ducts right hemihepatectomy |
