解剖性肝切除在治疗双侧肝内胆管结石中的临床应用价值

目的探讨解剖性肝切除在双侧肝内胆管结石治疗中的应用价值．方法收集2010年5月至2012年5月手术治疗的57例双侧肝内胆管结石患者的临床资料，其中解剖性肝切除32例，非解剖性肝切除25例，比较这2种手术方式在治疗双侧肝胆管结石病的效果．结果解剖性肝切除组患者术中出血量（436±48．162）mL较对照组（763±37，645）mL明显减少，差异有统计学意义（P〈0．05）．术后肝功能恢复情况：术后第3天总胆红素及AST均显著低于对照组（P〈0．05）；术后患者住院时间也低于对照组（P〈0．05）．2组在手术时间、术后并发症及结石残留率方面差异无统计学意义（P〉0．05），但对照组术后有1例患者死于肝功能衰竭．结论解剖性肝切除具有在尽可能保留残肝功能前提下，做到彻底清除病灶，术后结石残余率、复发率低，术后恢复快等特点，值得推广．

Application of Anatomical Liver Resection in Treatment of Bilateral Hepatolithiasis

Objective To explore the value of anatomical liver resection in the treatment of bilateral intrahepatic biliary lithiasis. Methods We collected the clinical data of 32 patients with bilateral intrahepatic biliary lithiasis who received anatomical liver resection and 25 patients who recevied non-anatomical liver resection from May 2010 to May 2012 in our hospital and Sun Yat-sen Memorial Hospital. We comapred the therapeutic efficacy of these two operative modalities in the diagnosis and treatment of bilateral intrahepatic biliary lithiasis. Results The intraoperative blood loss was 436 ±48.162 mL in patients who received anatomical liver resection, and was significantly less than that in the control group （763 ±37.645ml） （ P 〈 0.05 ） . Postoperative liver function status： for patients who received anatomical liver resection, on the third day after operation, the total bilirubin and AST were significantly lower than those in the control group （ P 〈 0.05 ）, and the postoperative hospitalization time was also shorter than that of the control group （ P 〈 0.05 ） . The two groups in the operation time, postoperative complications and residual calculus had no significant difference （ P〉0.05 ） , but there 1 patients died of liver failure in the control group. Conclusions Anatomical liver resection is a favorable method to completely remove the lesions under the premise of retaining the residual liver function as much as possible. The rate of remnant biliary lithiasis and recurrence is lower and the recovery is quicker in these patients after anatomical liver resection. Thus, anatomical liver resection is worthy of promotion