目的:探讨“一站式”外科治疗区域型肝胆管结石病的可行性.方法:回顾性分析2013年1月-2016年8月收治的74例区域型肝胆管结石病患者的临床资料.患者均行“一站式”外科治疗,即以规则性肝切除为基础,依靠术中B超和胆道镜的指引,一次性去清结石、切除病变胆管及病损性肝脏.结果:74例患者中,术前影像学判断结石分布符合率达94.6％(70/74).74例均行规则性肝切除,左半肝切除21例,左外叶切除8例,右半肝切除17例,右后叶切除16例,右前叶切除4例,右后叶+左外叶切除5例,扩大右半肝切除3例;行解剖性肝切除49例(66.2％);7例曾行胆肠内引流患者中5例因吻合口狭窄加行吻合口重建;71例行T管引流术,另外3例患者因重建胆肠吻合口后预留肝总管短未放置T管;平均手术时间(235.7±35.6) min,平均出血量(415.3±106.8) mL.无死亡病例,11例出现并发症经保守治疗好转;术后平均住院时间为(9.2±4.1)d.6例术后胆道T管造影可疑结石,门诊再行胆道镜检查或取石.所有患者获随访3～24个月,2例曾行胆肠内引流吻合口未重建者期间出现过1次胆道感染,保守治疗好转;21例胆总管结石复发予以ERCP+EST处理.结论:严格的术前评估,选择合适的病例,“一站式”外科治疗区域型肝胆管结石病安全可行,且疗效满意.“,”Objective:To investigate the feasibility of“one-stop” surgical treatment for regional hepatolithiasis.Methods:The clinical data of 74 patients with regional hepatolithiasis admitted from January 2013 to August 2016 were retrospectively analyzed.All patients underwent “one-stop” surgical treatment,i.e.,one-session performance of complete stone removal and resection of the biliary strictures and impaired portion of the liver based on regular liver resection and guided by intraoperative B-type ultrasonography and cholangioscopy.Results:In the 74 patients,the coincidence rate of stone distributions by preoperative imaging examinations was 94.6％ (70/74).All patients underwent regular hepatectomy that included left hemihepatectomy in 21 cases,left lateral lobectomy in 8 cases,right hemihepatectomy in 17 cases,right posterior lobectomy in 16 cases,right anterior lobectomy in 4 cases,right posterior lobectomy plus left lateral lobectomy in 5 cases and extended right hemihepatectomy in 3 cases;anatomical hepatectomy was performed in 49 patients (66.2％);5 of the 7 cases who had internal biliary-intestinal drainage previously underwent additional reconstruction of the anastomosis due to anastomotic stenosis;71 cases underwent T-tube drainage,the other 3 cases did not undergo T-tube placement due to short length of the preserved common hepatic duct after reconstruction of the anastomosis;the average operative time was (235.7±35.6) min and the average of blood was (415.3±106.8) mL.No deaths occurred,and postoperative complications occurred in 11 patients,all of which were improved by conservative treatments;the average length of postoperative hospital stay was (9.2±4.1) d.Six patients with suspicious residual stones by postoperative T-tube cholangiography underwent outpatient cholangioscopy or stone extraction.All patients were followed-up for 3 to 24 months,biliary infection occurred once in the 2 cases who did not undergo reconstruction of the anastomosis of the previous biliary-intestinal drainage,and 21 patients had stone recurrence in the common bile duct and were treated by ERCP+EST.Conclusion:After rigorous preoperative evaluation and selection of suitable patients,“one-stop” surgical treatment for regional hepatolithiasis is safe and feasible,with favorable efficacy.