摘要
目的对比分析不同外科方法治疗肝胆管结石的疗效差异,探讨肝胆管结石不同手术方式的合理选择。方法回顾性分析四川绵阳四〇四医院2013年10月至2017年12月120例进行肝胆管结石手术的病例资料,根据处理结石或病灶的方式不同,分为胆管切开组(胆管切开取石术,n=34)、肝段切除组(肝部分切除术,n=65)、修复重建组(肝门部胆管狭窄修复重建术,n=21),再根据是否通过微创操作,分为开腹手术组(开腹肝胆管结石手术,n=74)、腔镜手术组(腹腔镜肝胆管结石手术,n=46)。统计分析不同手术方法治疗后患者结石残余情况、并发症发生情况、疗效的差异。结果 120例肝胆管结石患者手术全部成功,胆管切开组、肝段切除组和修复重建组结石残余率[20.6%(7/34) vs 13.8%(9/65) vs 9.5%(2/21)]、并发症发生率[17.6%(6/34) vs 32.3%(21/65) vs 28.6%(6/21)]、疗效“优良”构成比[97.1%(33/34) vs89.2%(58/65) vs 95.2(20/21)]差异无统计学意义(P>0.05),开腹手术组和腔镜手术组结石残余率[17.4%(8/74) vs 13.5%(10/46)]、疗效“优良”构成比[90.5%(67/74) vs 95.7%(44/46)]差异无统计学意义(P>0.05),但腔镜手术组并发症发生率较开腹手术组更低[43.2%(32/74) vs 23.9%(11/46)],差异有统计学意义(P<0.05)。结论(1)术前充分了解患者病情,根据手术适应证妥善选择三种处理结石或病灶的方式,能取得满意疗效;(2)腹腔镜下进行肝胆管结石手术,能获得与开腹手术同样的安全性和疗效,且创伤更小、并发症更少,可作优先选择。
Objective To compare and analyze the efficacy of different surgical methods for the treatment on hepatolithiasis, and to explore the reasonable choice. Methods The clinical data of 120 patients with hepatolithiasis treated in Sichuan Mianyang 404 Hospital from Oct. 2013 to Dec. 2017 were retrospectively analyzed. Scheme 1: according to the ways of dealing with stones or lesions, patients were divided into cholangiotomy group (cholangiotomy, n=34), hepatectomy group (partial hepatectomy, n=65), repair and reconstruction group (repair and reconstruction of hepatic hilar biliary stricture, n=21). Scheme 2: according to whether or not through minimally invasive operation, patients were divided into open operation group (open hepatolithiasis, n=74), laparoscopic operation group (laparoscopic hepatolithiasis, n=46). The residual stone, complications and efficacy of different group were statistically analyzed. Results All 120 patients with hepatolithiasis were successfully operated. There was no significant difference in residual stone rate [20.6%(7/34) vs 13.8%(9/65) vs 9.5%(2/21)], incidence of complications [17.6%(6/34) vs 32.3%(21/65) vs 28.6%(6/21)] and ratio of "excellent or good" composition of efficacy [97.1%(33/34) vs 89.2%(58/65) vs 95.2 (20/21)] mong cholangiotomy group, hepatectomy group, repair and reconstruction group (P>0.05). There was no significant difference in residual stone rate [17.4%(8/74) vs 13.5%(10/46)] and ratio of “excellent or good” composition of efficacy [90.5%(67/74) vs 95.7%(44/46)] between open operation group and laparoscopic operation group (P>0.05), but incidence of complications in laparoscopic operation group was lower than that in open operation group [43.2%(32/74) vs 23.9%(11/46)], the difference was significant (P<0.05). Conclusion (1)Fully understanding the patients’ condition before operation and properly choosing three ways to deal with stones or lesions according to indications of operation can achieve satisfactory results.(2)Laparoscopic hepatolithiasis can achieve th
作者
胥丹
胡晋太
韩保俊
黄凤德
肖海波
XU Dan;HU Jin-tai;HAN Bao-jun;HUANG Feng-de;XIAO Hai-bao(Department of Hepatobiliary Surgery, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan 621000, China)
出处
《肝胆胰外科杂志》
CAS
2019年第9期531-535,544,共6页
Journal of Hepatopancreatobiliary Surgery
