关键词: 复杂肝胆管结石, 肝部分切除术, 疗效, 策略

Abstract: Objective To explore the efficacy and strategy of hepatectomy for complicated hepatolithiasis.Methods Fifty-six patients with complicated hepatolithiasis were divided into open hepatectomy group (32 cases) and laparoscopic hepatectomy group (24 cases).The operation mode,operation time,operation bleeding volume,hospitalization time,postoperative complication rate,residual stone rate and recurrence rate were analyzed.Results The operation time was (367.81±113.46) minutes,the operation bleeding volume was 534.00(300.00,1 000.00) ml,and the hospitalization time was (25.16±7.51) days in open surgery group.The operation time was (320.46±110.89) minutes,the operation bleeding volume was 200.00(200.00,600.00) ml,and the hospitalization time was (19.71±6.55) days in laparoscopic surgery group.There were statistically significant differences between the two groups in the operation bleeding volume and hospitalization time (all P＜0.05).Bile leakage occurred in 2 cases (6.25%) and residual stones in 10 cases (31.25%),3 cases had recurrence of calculi(9.38%).Laparoscopic operation group:3 cases (12.5%) had residual stones,3 cases had recurrence of calculi(8.33%) .There were no statistically significant differences in postoperative complications,stone remnant and recurrence rates between the two groups（P>0.05）.Conclusions Biliary drainage should be completed before hepatectomy for complicated hepatolithiasis.If it is difficult to perform anatomic hepatectomy,the lesion should be removed as far as possible.Laparoscopic surgery has the advantages of less bleeding and shorter hospital stay.Combined with PTCS,ERCP and other technologies can make the treatment of complex hepatolithiasis accurate and minimally invasive.

Key words: complicated hepatolithiasis, hepatectomy, efficacy；strategy