探讨胆道变异伴复杂肝胆管结石手术处理的疗效，并文献复习。

回顾性分析2024年4月在川北医学院附属医院接受手术治疗的1例胆道变异伴复杂肝胆管结石患者临床资料。患者女，36岁，因“上腹部疼痛不适1月余”入院。AST 88 U/L、ALT 217 U/L、TB 27.8 μmol/L、DB 11.2 μmol/L。上腹部MRI+MRCP示胆总管上中段、肝门部胆管及左右肝内胆管结石伴胆管扩张、胆管炎；胆道变异：右前叶与左肝管并行汇入肝总管，右后叶胆管扩张并于低位侧后方汇入胆总管；胆囊胆汁淤积。初步诊断：肝内外胆管结石伴胆管炎；解剖性胆道变异，Couinaud分型Ⅳ型；肝功能不全；胆囊内胆汁淤积。患者签署手术知情同意书，符合医学伦理学规定。

术前综合评估后于2024年4月10日全麻下行腹腔镜右半肝切除术+胆囊切除术+胆道镜探查取石术+胆管修补整形术+T管引流术。手术时间185 min，术中出血约100 ml，术中未输血。术后第10天康复出院。病理学检查未见癌变，（右半肝）部分肝细胞内见色素沉积，汇管区及小周边纤维增生，淋巴细胞浸润，肝内胆管扩张。患者出院后采取门诊和电话的方式随访，术后1个月T管造影等检查确定无结石残留后拔除T管。术后随访监测病情和预防复发。截至投稿日无复发。

充分的术前评估、精细的术中操作、细致的术后管理可有效降低腹腔镜肝切除在治疗肝胆管结石和处理肝脏中胆管和血管解剖变异中的风险，提高手术的安全性和疗效。

To investigate surgical treatment and clinical efficacy of biliary tract variations complicated with complex hepatolithiasis, and perform literature review.

Clinical data of a patient diagnsed with biliary duct variations and complex hepatolithiasis who underwent surgical treatment in the Affiliated Hospital of North Sichuan Medical College in April, 2024 were retrospectively analyzed. A 36-year-old female patient was admitted due to "epigastric pain and discomfort for more than 1 month". AST level was 88 U/L, ALT 217 U/L, TB 27.8 μmol/L and DB 11.2 μmol/L, respectively. MRI and MRCP of the upper abdomen showed stones in the upper and middle common bile duct, hilar bile duct and left and right intrahepatic bile ducts complicated with bile duct dilatation and cholangitis. Biliary duct variations: the right anterior lobe and the left hepatic duct merged into the common bile duct in parallel, and the right posterior lobe bile duct dilated and merged into the common bile duct at the lower posterior end; and cholestasis. Preliminary diagnosis: intrahepatic and extrahepatic bile duct stones complicated with cholangitis; anatomical biliary variants, Couinaud segement Ⅳ; hepatic insufficiency; and cholestasis. The informed consent of this patient was obtained and the local ethical committee approval was received.

After comprehensive evaluation before operation, laparoscopic right hemihepatectomy, cholecystectomy, choledochoscopic exploration and lithotomy, bile duct repair and plasty combined with T tube drainage were performed under general anesthesia on April 10, 2024. The operation time was 185 min, intraoperative bleeding was estimated 100 ml, and no blood transfusion was delivered intraoperatively. The patient was discharged at postoperative 10 d. Pathological examination showed no sign of canceration. Pigment deposition was seen in partial cells of the right lobe, fibrous hyperplasia in portal area and surrounding area, lymphocyte infiltration and intrahepatic bile duct dilatation were also found. The patient was followed up by outpatient and telephone after discharge. T-tube cholangiography at postoperative 1 month confirmed no residual stones and T tube was removed subsequently. Postoperative follow-up was conducted to monitor the condition and prevent the recurrence. No recurrence has been reported as of the submission date.

Comprehensive preoperative evaluation, careful intraoperative operation and attentive postoperative management can effectively reduce the risk of anatomic variations of bile duct and vessels during laparoscopic hepatectomy in the treatment of hepatolithiasis, and enhance surgical safety and efficacy.