探讨Glisson鞘解剖性肝切除术治疗肝内胆管结石的手术方式、特点及其临床疗效。

回顾性分析2009年5月至2014年7月在南方医科大学附属顺德第一人民医院行Glisson鞘解剖性肝切除术的37例肝内胆管结石患者临床资料。其中男9例，女28例；年龄27～83岁，中位年龄53岁。按2007年中华医学会外科学分会胆道外科学组肝内胆管结石分型，Ⅰ型27例，Ⅱ型10例。患者均签署知情同意书，符合医学伦理学规定。患者行Glisson鞘解剖性肝切除术及术中胆道镜取石。观察患者手术情况、术后胆漏、肝衰竭、腹腔感染等并发症发生情况及结石清除率。

所有患者均顺利完成手术。单个肝段切除术4例，Ⅲ段及部分Ⅷ段切除1例，左外叶切除10例，左半肝切除13例，Ⅳ段及Ⅴ段切除1例，右前叶切除1例，右后叶切除4例，右半肝切除2例，左外叶及右后叶切除1例。患者的中位手术时间300（140～450）min，术中出血量350（10～800）ml。无围手术期死亡。术后无胆漏、肝衰竭及腹腔感染发生。Ⅰ型结石患者结石清除率为93% (25/27)，Ⅱ型结石清除率为6/10，总的结石清除率为84%（31/37）。

Glisson鞘解剖性肝切除术具有肝脏管道解剖相对简便，胆管误伤机会低，肝脏切除边界较易判断，易于保护正常尾状叶以及术中解剖清晰等优点，是治疗肝内胆管结石安全、实用的肝切除方式。

To investigate the surgical procedure, characteristics and clinical efficacy of anatomical hepatectomy with Glissonian approach for hepatolithiasis.

Clinical data of 37 patients with hepatolithiasis who underwent anatomical hepatectomy with Glissonian approach in the First People's Hospital of Shunde Affiliated to Southern Medical University between May 2009 and July 2014 were retrospectively analyzed. Among the patients, 9 were males and 28 were females with the age ranging from 27 to 83 years old and the median of 53 years old. According to the hepatolithiasis classification of Biliary Tract Surgery Group of Surgery Branch of Chinese Medical Association (2007), 27 cases were with typeⅠhepatolithiasis and 10 cases were with type Ⅱ hepatolithiasis. The informed consents of all patients were obtained and the local ethical committee approval was received. Anatomical hepatectomy with Glissonian approach and intraoperative cholangioscopic lithotomy were performed on the patients. The conditions during operation, postoperative complications of bile leakage, liver failure, abdominal infection, and stone clearance rate were observed.

All patients completed the operations successfully. Four cases underwent resection of single segment, 1 of segment Ⅲ and part of segment Ⅷ, 10 of left lateral lobe, 13 of left lobe, 1 of segment Ⅳ and Ⅴ, 1 of right anterior lobe, 4 of right posterior lobe, 2 of right lobe, and 1 of left lateral lobe and right posterior lobe. The median length of operation was 300(140-450) min and the intraoperative blood loss was 350(10-800) ml. No death was observed during perioperative period. And no bile leakage, liver failure or abdominal infection was observed after operation. The stone clearance rate of patients with typeⅠand type Ⅱ hepatolithiasis was respectively 93%(25/27) and 6/10, and the overall stone clearance rate was 84% (31/37).

Anatomical hepatectomy with Glissonian approach has the advantages of relatively easy dissection of intrahepatic ducts, low possibility of accidental injury to biliary ducts, easy discrimination of liver resection border, easy protection of normal caudate lobe and clear intraoperative dissection. Thus, it is a safe and practical liver resection method for hepatolithiasis.