摘要
目的探讨解剖性肝切除（anatomic hepatectomy，AH）和肝组织切开取石（lithotomy of liver parenchyma，LLP）治疗区域型肝内胆管结石的近期和远期治疗效果。方法回顾性分析2012年1月至2015年6月收治的区域型肝内胆管结石患者106例．根据手术方式的不同将其分为2组，其中行肝组织切开取石59例，行解剖性肝切除47例，比较二者残余结石、肝断面感染、肝功能恢复时间、术后断面胆漏、结石复发和病死率。结果2组患者肝功能恢复时间（2．96d比2．82d，P〉0．05）比较差异无统计学意义。AH组残余结石发生率低（2例比13例，P〈0．01），肝断面感染机会少（1例比21例，P〈0．01），术后胆漏发生率低（0例比7例，P〈0．05），中位随访31个月（3—48个月），AH组结石复发率小（0例比12例，P〈0．01），两组患者均无死亡。结论解剖性肝切除是治疗区域型肝内胆管结石安全有效的方法，有较高的结石清除率和相对少的外科并发症，应作为区域型肝内胆管结石的首选治疗方案。
Objective To evaluate anatomic hepatectomy （AH） vs lithotomy of liver parenchyma （LLP） for regional hepatolithiasis. Methods From January 2012 to June 2015, fifty-nine cases underwent LLP and 47 received AH. Clinical end-points included residual stones, infection of the raw surface of liver remnant, time to restoration of liver function, bile leakage, recurrent stones, morbidity and mortality. Results The time of liver function restoration was not statistically different between the two groups （2. 96 d vs. 2. 82 d,P 〉0. 05）. Patients in AH group suffered from less residual stones （2 cases vs. 13 cases,P 〈 0.01 ） , lower infection rate of the raw surface of liver remnant （ 1 case vs. 21 cases ,P 〈0. 01 ）, and less bile leakage rate （ 0 case vs. 7 cases, P 〈 0. 05 ）. With a median follow-up of 31 months （ range 3 - 48 mon）. AH group suffered from less recurrent hepatolithiasis （ 0 case vs. 12 cases, P 〈 0. 01 ） . There was no mortality in both groups. Conclusions Anatomic hepatectomy is a safe and effective treatment for hepatolithiasis, with a high stone clearance rate and low surgical complications.
出处
《中华普通外科杂志》
CSCD
北大核心
2016年第8期643-646,共4页
Chinese Journal of General Surgery
关键词
胆结石
肝切除术
Cholelithiasis
Hepatectomy
