目的: 探讨沿肝纤维化边界引导肝胆管结石左半肝切除的临床疗效。方法: 回顾分析湖南省人民医院2018年06月—2020 年09月收治的45例肝胆管结石病患者,实验组23例,常规组22例,比较两组患者术前1 d,术后1 d、5 d复查的总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）及白蛋白（ALB）、手术时间、术中出血以及术后活动情况等指标。结果: 两组患者均顺利完成手术,术后恢复良好,术后2月复查T管造影明确无结石残留。实验组与常规组术前1 d,术后1d、5 d复查的TBIL、ALT、AST及ALB等指标两组间差异无统计学意义;在手术时间、术中出血等方面数据提示两组间存在统计学差异;术中肝中静脉显露两组间差异无统计学意义;在术后下床活动、术后肠道功能恢复时间、术后进食时间、术后住院天数以及术后疼痛等方面两组间差异无统计学意义。结论: 沿肝纤维化边界引导肝胆管结石左半肝切除比沿缺血线为边界引导肝胆管结石左半肝切除有更好的临床应用价值。

Objective To investigate the clinical effects of left hepatectomy with hepatolithiasis guided by liver fibrosis border and anatomical left hepatectomy with hepatolithiasis guided by the ischemic line. Methods Forty-five patients with hepatobiliary lithiasis in Hunan Provincial People's Hospital from June 2018 to September 2020 were retrospectively analyzed.23 cases in the experimental group and 22 cases in the conventional group. The patients in both groups were compared with thetotal bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) on the last 1 day before operation, on the 1st day and the 5th day after operation. operation time, intraoperative bleeding, Middle hepatic vein exposure, postoperative ambulation, postoperative intestinal function recovery time, postoperative eating time, postoperative hospital days and postoperative pain and other indicators on the last 1 day before operation, on the 1st day and the 5th day after operation. Results The two groups of patients were successfully completed surgery, postoperative recovery were good. T-tube Cholangiography confirmed the absence of residual stones after 2 months later. Comparing with thetotal bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) on the last 1 day before operation, on the 1st day and the 5th day after operation, there is no significant difference between the two group. In the operation time, intraoperative bleeding, the data suggest that there is statistical differences between the two groups. There is no significant difference with the Middle hepatic vein exposure between the two groups. The postoperative ambulation, postoperative intestinal function recovery time, postoperative eating time, postoperative hospital stay, Postoperative pain and other aspects of the two groups showed no significant difference. Conclusion The left hepatectomy with hepatolithiasis guided by liver fibrosis border based on the hepatic blood flow control technique of anatomical hepatectomy, relative to the characteristics of hepatolithiasis lesions, has a better clinical value in the left hepatectomy with significant hepatic atrophy and fibrosis in hepatolithiasis .