Objective To investigate the clinical effect of anatomical hepatectomy in the treatment of intrahepatic bile duct stones.Methods A retrospective analysis was performed for the clinical data of 117 patients with intrahepatic bile duct stones who underwent hepatectomy in The Affiliated Hospital of Zunyi Medical College from July 2013 to December 2015.Among these patients,66 underwent anatomical hepatec-tomy (anatomical hepatectomy group)and 51 underwent irregular hepatectomy (irregular hepatectomy group).The time of operation,intra-operative blood loss,volume of drainage on the day after surgery,serum levels of aspartate aminotransferase (AST),alanine aminotrans-ferase (ALT),and total bilirubin (TBil),and length of postoperative hospital stay were recorded,as well as the patients′general status, liver function parameters,and abdominal ultrasound,and CT or MRI findings from 2 months to 2 years after discharge,to observe the pres-ence or absence of residual stones or stone recurrence.The t -test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results Compared with the irregular hepatectomy group,the an-atomical hepatectomy group had a significantly longer time of operation (303.1 ±51.6 min vs 246.5 ±36.2 min,t =6.963,P <0.01), but it had significantly less intraoperative blood loss (467.9 ±80.6 ml vs 565.9 ±92.0 ml,t =6.026,P <0.01),a significantly lower vol-ume of drainage on the day after surgery (212.6 ±54.9 ml vs 358.3 ±69.4 ml,t =12.682,P <0.01),a significantly lower incidence rate of complications (10.6% vs 25.5%,χ2 =4.497,P =0.034),a significantly lower rate of postoperative residual stones (4.5% vs 15.7%,χ2 =4.192,P =0.041),and a significantly shorter length of hospital stay (13.4 ±2.6 d vs 21.9 ±3.2 d,t =15.427,P <0.01).On day 3 after surgery,the anatomical hepatectomy group had significantly lower serum levels of ALT,AST,and TBil than the irreg-ular hepatectomy group (AST:62.7 ±25.4 U /L vs 114.8 ±37.0 U /L,t =9.024,P <0.01;ALT:91.3 ±35.7 U /L vs 149.5 ±53.3 U /L,t =7.067,P <0.01;TBil:31.8 ±10.4 μmol/L vs 51.3 ±14.3 μmol/L,t =8.531,P <0.01).Conclusion Under the premise of preserving the function of the residual liver,anatomical hepatectomy can completely remove the lesions and has the features of low residual stone rate,low recurrence rate and rapid postoperative recovery.It has a better clinical effect than irregular hepatectomy.%目的：探讨解剖性肝切除术在治疗肝内胆管结石中的疗效。方法回顾性分析2013年7月－2015年12月于遵义医学院附属医院行肝切除术的117例肝内胆管结石病患者的临床资料，其中行解剖性肝切除66例（试验组）、非规则性肝切除51例（对照组）。记录患者手术时间，术中出血量，术后当日引流量，术后第3天血清 AST、ALT 及 TBil 值，术后住院时间，以及出院后2个月～2年患者的一般情况，肝功能指标，腹部 B 超、CT 或 MRI 检查结果，统计有无结石残留、复发情况。计量资料组间比较采用 t 检验，计数资料组间比较采用χ2检验。结果试验组的手术时间显著长于对照组[（303．1±51．6）min vs （246．5±36．2）min，t ＝6．963，P＜0．01），但是与对照组相比，其术中出血量少[（467．9±80．6）ml vs （565．9±92．0）ml，t ＝6．026，P ＜0．01]、术后当日引流量少[（212．6±54．9）ml vs （358．3±69．4）ml，t ＝12．682，P ＜0．01]、术后并发症少（10．6％ vs 25．5％，χ2＝4．497，P ＝0．034）、术后残石率低（4．5％ vs 15．7％，χ2＝4．192，P ＝0．041）、住院时间短[（13．4±2．6）d vs （21．9±3．2）d，t ＝15．427，P ＜0．01]，试验组术后第3天血清 AST、ALT、TBil 水平均显著低于对照组[AST：（62．7±25．4）U ／L vs （114．8±37．0）U ／L，t ＝9．024，P ＜0．01；ALT：（91．3±35．7）U ／L vs （149．5±53．3）U ／L，t ＝7．067，P ＜0．01；TBil：（31．8±10．4）μmol ／L vs （51．3±14．3）μmol ／L，t ＝8．531，P ＜0．01]。结论解剖性肝切除在尽可能保留残肝功能的前提下，做到彻底清除病灶，具有术后残石率及复发率低、术后恢复快等特点，其疗效优于非规则性肝切除。
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