近年来，胆石症的发病谱已发生了根本性的变迁，一些大城市的胆囊结石发病率逐步增加，过去常见的肝内胆管结石已明显减少； 但多数地区肝内胆管结石发病率仍较高，仍是我国的常见病之一，其治疗也仍是胆道外科中的困难问题。运用现代肝脏外科手术技术，处理肝门部和肝内胆管及血管，获得良好的显露，基本上可达到“解除梗阻，去除病灶，通畅引流”的肝胆管结石外科治疗原则。由于肝内胆管结石本身的复杂性，目前尚无一种手术方式可使所有患者获得满意效果，因此，应根据患者的实际情况采用“个体化治疗方案”。常用的手术方法有胆管探查取石、胆肠引流、肝叶切除术等。根据病情、患者的身体素质、技术条件和病变的性质等综合考虑来决定术式。
目的探讨肝内胆管结石合并肝胆管癌的临床诊断和治疗经验。 方法回顾性分析我院手术治疗28例肝内胆管结石合并肝胆管癌的病例资料。结果本组28例占同期肝内胆管结石病例的6.7%。术前各类影像学检查发现癌灶17例，5例获细胞学检查确诊。术中7例经快速组织活检证实。另4例系术后确诊。肿瘤多为腺癌，位于肝门胆管18例，肝内胆管9例，肝内、肝门部广泛浸润1例。根治性肿瘤切除8例，获随访6例，平均生存23个月； 姑息性肿瘤切除8例，获随访6例，平均生存11个月； 仅行外引流者7例，其中3例于术后2周内死亡，3例术后9个月内死亡，1例生存4个月后失访。结论长期肝内胆管结石刺激及继发感染是肝胆管癌发生的重要因素。联合应用影像学检查结合病理活检获得早期诊断和选择合理的根治性肝切除术是提高疗效的有效措施。
目的 减少肝内胆管结石术后的残留。方法 回顾性分析近5年我科收治的50例肝内胆管结石病例行病灶肝切除并结合术中、术后胆道镜应用的近期疗效及术后残石率。结果 术后近期并发症发生率为8%，无胆漏、肝衰及手术死亡发生，术后B超、逆行T管造影及术后胆道镜检查证实的即期残石率仅4%（2例）。结论 减少肝内胆管结石术后结石残留的关键是术中术后胆道镜的使用，肝内及肝门胆管狭窄的彻底处理； 依据狭窄胆管所引流区域行“根治性”的肝组织切除是取尽结石，清除病灶的合理方法。
An retrospective analysis of 112 cases with localized left hepatolithiasis (LLH) treated in our center in recent two decades was made. The results showed: ①Coexisting involvements of both left external hepatic duct (LEHD) and left medial hepatic duct (LMHD) were the most common pathological pattern (83.08%), came next the only LEHD involvement (12.31%). There was no localized LMHD caculi in this group. ②The rate of concomitant LHD stricture was 59.82% and that of LMHD or LEHD were 84.85% and 84.00% respectively, in which severe degrees dominate. ③Lateral segmentectomy was the most common clinical practice for LLH (58.93%), and left lebectomy was much less frequently used (12.50%), although the latter led to a significantly smaller rate of residual (7.14% vs 21.21%) and had a satification follow-up rate of 85.71% being superior to lateral segmentectomy (46.97%), or cholangiojejunostomy (40.00%), bile duct exploration and drainage (0). ④The most common prognostic factors were residual or recurrent stones of LMHD (62.50%) and residual LHD stricture (37.50%). ⑤There was no significant difference between left lobectomy and lateral segmentectomy in length of operation, intraoperative bleeding, and postoperative complications. The results indicate that too much dependence on lateral segmentectomy in the management of LLH is one of the most important factors affecting the longterm results, for which left lobectomy is an applicable and safe therapy of choice.
In 1983-1994,748 cases hepatocholelithiasis had been treated in our department, in which 372 patients underwent hepatectomy and 43 patients underwent hepatectomy of the quadrate lobe. Hepatectomy of the quadrate lobe has been performed to treat all kinds of hepatocholelithiasis, it is easy to expose 1 or 2 degree branch of biliary tree, incise the hepatobiliary stricture and perform hepatocholangiojejunostomy in the hepatic hilum.
Objective To evaluate the value of the application of laparoscopic hepatectomy in hepatolithiasis. Methods The clinical data of 35 patients with hepatolithiasis performed with laparoscopic hepatectomy were analyed retrospectively. Operations included laparoscopic left lateral sectionectomy， left hemihepatectomy， cholecystectomy， choledocholithotomy， choledochoscopy， and T-tube drainage. Results All operations of 35 patients were performed complete laparoscopically. The mean operative time was 205 minutes （150-370minutes）. The mean blood loss was 330mL（50-1 000mL）. Patients felt less pain without administration of painkillers after operation. Ambulation resumed on thefirst day and liquid diet resumed on the second day after operation. The average hospital stay was 12.7 days （4-15d）. There was no death. The excellent and good rate of operation was 71.4% and 25.7%， respectively. Conclusion Laparoscopic hepatetomy is an effect and minimally invasive alternative method for hepatolithiasis in slective patients.
Objective To discuss the effect and prognosis of the Da Vinci surgical system assisted surgical treatment for complex hepatolithiasis. Methods The clinical data of 15 patients with complex calculus of intraheoatic duct who accepted surgical therapy at General Hospital of the Second Artillery Corps of PLA from January 2009 to August 2011 were analyzed retrospectively. Results All operations of 15 patients were performed successfully, no case of converting to laparotomy， no injury of the important blood vessels and organs in surgical procedures. Postoperative complications occurred in 4 cases （26.7%）. Among them, there were 1 case （6.7%） of hemobilia, 1 case （6.7%） of lung infection, 2 cases （13.3%） of liver surface bleeding, and no case of death and liver failure occurred during the perioperative period. All patients （100%） had follow-up visited with a median time of 11 months （ranging from 3 months to 2 years）, 12 cases （80.0%） acquired good curative effect, 3 cases （20.0%） of residual stones were found, 1 case （6.7%） of recurrence stones were found. Conclusion There are enormous potential for Da Vinci surgical system assisted surgical treatment of complex hepatolithiasis, which can be used in elderly patients，and patients with multiple surgical history, poor liver function, acute cholangitis, and so on.
ObjectiveTo investigate the effectiveness of epidermal growth factor receptor antagonist (AG-1478) on chronic proliferative cholangitis (CPC), so as to investigate new treatment approach for hepatolithiasis associated with CPC. MethodsForty-six SD rats were divided into 5 groups: CPC model group (n=10), only made models. AG-1478 treatment group (divided into 3 mg/kg， 6 mg/kg， and 12 mg/kg groups, n=10 per group), the common bile ducts in CPC animal model received an intralumenal administration of AG-1478 at the meantime of modeling, followed by intraperitoneal AG-1478 injection of 1.5 mg/(kg·d) for 7 days. Sham operation group (SO group, n=6). Subsequently, histopathological observation, immunohistochemistry, real time PCR， and Western blot were used to evaluate the mRNA expression and influence of AG-1478 on the hyperplasia （EGFR， ki-67， BrdU， collagen Ⅰ protein） and lithogenic potential (Mucin 5AC) of CPC. ResultsCompared with CPC model group, the expressions of EGFR, ki-67， and BrdU were obviously decreased in the AG-1478 treatment group. Also, the inhibition of hyperplasia of biliary epithelium and collagen fibers were confirmed by histopathological observation. Additionally, the expressions of Mucin 5AC mRNA and collagen Ⅰ protein remarkable decreased in the AG-1478 treatment group (Plt;0.05). Conclusions EGFR inhibitor (AG-1478) could shows inhibitory effectivenss on the CPC-mediated hyperplasia and lithogenic potential, and therefore holds promise as the new treatment approach for CPC.