中国实用外科杂志

中国实用外科杂志

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右半肝切除术在肝胆管结石治疗中的应用（附48例报告）

殷晓煜，刘    鑫，陈    伟，蔡建鹏，陈    东，汪    谦，赖佳明，梁力建   

  1. 中山大学附属第一医院胆胰外科，广东广州510080
  • 出版日期:2016-03-01 发布日期:2016-03-01

  • Online:2016-03-01 Published:2016-03-01

摘要：

目的    探讨右半肝切除术在治疗局限于右肝或以右肝分布为主的肝胆管结石病人的安全性及临床疗效。方法    回顾性分析2010年1月至2014年12月于中山大学附属第一医院接受右半肝切除术治疗的48例肝胆管结石病人临床资料。结果    共有48例肝胆管结石病人接受右半肝切除术，其中男性17例，女性31例。中位年龄56岁。16例（33.3%）病人有既往胆道手术病史。在48例病人中，单纯右半肝切除术2例，33例联合胆总管探查术、T管引流术，13例联合胆肠吻合。无围手术期死亡，并发症发生率为25.0%（12/48），包括胆漏6例（12.5%），腹腔感染4例（8.3%），手术切口感染4例（8.3%），轻度肝功能不全1例（2.1%），胸腔积液1例（2.1%）。9例（18.8%）病人术后残留结石，其中7例经术后胆道镜取净结石。42例（87.5%）病人获得随访，平均随访33.3个月；39例（92.8%）病人无再发胆管结石。结论    在治疗局限于右肝或以右肝分布为主的肝胆管结石病人，右半肝切除术具有术后结石残存率低、复发率低的优点，是安全、有效的治疗手段。

关键词: 右半肝切除, 肝胆管结石, 安全性, 远期疗效

Abstract:

Application of right hemihepatectomy in the treatment of hepatolithiasis：A report of 48 cases        YIN Xiao-Yu，LIU Xin，CHEN Wei，et al. Department of Pancreatobiliary Surgery，the First Affiliated Hospital，Sun Yat-Sen University，Guangzhou 510080，China
Corresponding author：YIN Xiao-Yu，E-mail：yinxy@medmail.com.cn
Abstract    Objective    To investigate the safety and long-term outcomes of right hemihepatectomy in treating the patients with hepatolithiasis，which was confined to or mainly involved in the right semi-liver. Methods    The clinical data of forty-eight patients with hepatolithiasis who underwent right hemihepatectomy between January 2010 and December 2014 in the First Affiliated Hospital，Sun Yat-Sen University were recruited in the study，and the clinical data and follow-up data were analyzed to evaluate its safety and long-term outcomes. Results    There was a total of 48 cases of hepatolithiasis undergone right hemihepatectomy，with 17 males and 31 females，and a median age of 56 years. Sixteen of them had histories of previous biliary surgery. In addition to right hemihepatectomy，the other operative procedures included hepaticojejunostomy in 13 cases，exploration of common bile duct with T tube drainage in 33 cases. There was no perioperative death，and postoperative morbidity was 25%(12/48)，including bile leakage in 6 cases，intra-abdominal infection in 4 cases，wound infection in 4 cases，mild hepatic dysfunction in 1 case and pleural effusion in 1 case. The residual stones were revealed by postoperative T-tube cholangiography in 9 cases (18.8%) and completely extracted viapostoperative choledochoscopy in 7 cases. Forty-two (87.5%) cases were successfully followed up with a median follow-up time of 33.3 months. About 92.8% of them (39/42) remained stone-free. Conclusion    Right hemihepatectomy is a safe and effective treatment for hepatolithiasis，which is confined to or mainly involved in the right semi-liver，with advantages of low incidences of residue stone and stone recurrence．

Key words: right hemihepatectomy, hepatolithiasis, safety, long-term outcome