Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Ann Surg. 2010 Jan;251(1):84-90. doi: 10.1097/SLA.0b013e3181b2f374.
This study aimed to evaluate the perioperative and long-term results of partial hepatectomy for patients with complicated bilateral primary hepatolithiasis.
Hepatolithiasis is best managed by a multidisciplinary approach. Definitive treatment can be offered using endoscopic, percutaneous, laparoscopic, or open surgical approaches. Partial hepatectomy is only indicated for recurrent, troublesome, localized, and severe disease affecting the liver.
From January 2000 to December 2006, 136 consecutive patients who underwent bilateral (n = 54) or unilateral (n = 82) hepatectomy for biliary strictures and bilateral primary hepatolithiasis in our center were included in this study. All patients had concomitant bile duct exploration. Their perioperative and long-term outcomes were analyzed.
The immediate stone clearance rates after bilateral and unilateral hepatectomy were 81.5% and 65.9%, respectively. Additional postoperative choledochoscopic lithotripsy raised the clearance rates to 85.2% and 81.7%, respectively. The hospital mortality rates were 5.6% and 0%, respectively, and the complication rates were 46.3% and 46.3%, respectively. The 5-year overall survival rates were 98% and 91.5%, respectively.
In selected patients with biliary strictures and bilateral hepatolithiasis, partial hepatectomy associated with choledochoscopic lithotripsy is a safe and efficacious treatment, with a high immediate stone clearance rate, a low long-term stone recurrence rate and good long-term survival.
本研究旨在评估复杂性双侧原发性肝胆管结石患者行部分肝切除术的围手术期和长期结果。
肝胆管结石最好采用多学科方法治疗。可通过内镜、经皮、腹腔镜或开腹手术等方法提供确定性治疗。只有当病变影响肝脏且出现复发性、难治性、局限性和严重疾病时，才考虑行部分肝切除术。
自 2000 年 1 月至 2006 年 12 月，我院对 136 例因胆管狭窄和双侧原发性肝胆管结石而行双侧（n=54）或单侧（n=82）肝切除术的患者进行了回顾性研究。所有患者均同时进行胆管探查。分析了他们的围手术期和长期结果。
双侧和单侧肝切除术后即刻结石清除率分别为 81.5%和 65.9%。额外的术后经内镜逆行胰胆管造影取石术使清除率分别提高至 85.2%和 81.7%。医院死亡率分别为 5.6%和 0%，并发症发生率分别为 46.3%和 46.3%。5 年总生存率分别为 98%和 91.5%。
在有胆管狭窄和双侧肝胆管结石的选择患者中，联合经内镜逆行胰胆管造影取石术的部分肝切除术是一种安全有效的治疗方法，具有较高的即刻结石清除率、较低的长期结石复发率和良好的长期生存率。
