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精准肝切除术与传统肝切除术治疗肝内胆管结石的效果比较
Efficacy comparison of precise and traditional liver resection in treatment of intrahepatic bile duct stones
文章发布日期:2015年09月06日  来源:  作者:张生军,刘敏丽,常琦,等  点击次数:1142次  下载次数:286次

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【摘要】:目的比较精准肝切除术与传统肝切除术在治疗肝内胆管结石中的作用。方法选择2008年12月-2014年12月延安大学附属医院行手术治疗的肝内胆管结石患者127例,根据手术方式分为精准肝切除术组(72例)和传统肝切除术组(55例)。比较两组患者手术时间、术中出血量、术后引流量、术后恢复时间、术后并发症(切口感染、胆瘘)、术后合并症(肺部感染、胸腔积液)、住院费用以及术后结石残留及复发等情况。计量资料的组间比较采用t检验,计数资料的组间比较采用χ2检验,采用生存函数分析生存资料。结果精准肝切除术组较传统肝切除术组在手术时间、术中出血量、术后引流量、术后恢复时间及住院费用方面的差异均具有统计学意义(t值分别为3.720、58.681、19.169、5.990、6.944,P值均<0.05);两组在术后并发胆瘘、切口感染及术后合并肺炎、胸腔积液等方面差异均无统计学意义(P值均>0.05);两组在术后结石残留率及结石复发率方面的差异亦均无统计学意义(P值均>0.05);对术后结石复发时间的生存分析表明,两组患者在结石复发时间上的差异均无统计学意义(P>0.05)。结论相较于传统肝切除术,精准肝切除术具有手术时间短、术中出血少、术后引流少、恢复快等优点,但同时存在住院费用高的不足。同时,精准肝切除组并未增加术后并发胆瘘、切口感染及术后合并肺炎、胸腔积液等的风险;也并未降低术后结石残留率及术后结石复发率。
【Abstract】:ObjectiveTo compare the efficacy of precise and traditional liver resection in the treatment of intrahepatic bile duct stones. MethodsOne hundred and twenty-seven patients with intrahepatic bile duct stones who were treated with surgery in our hospital from December 2008 to December 2014 were selected and divided into precise liver resection group (n=72) and traditional liver resection group (n=55) based on the type of surgery. The operation time, intraoperative blood loss, amount of postoperative drainage, postoperative time to recovery, postoperative complications (incision infection, biliary fistula, lung infection, and pleural effusion), hospitalization cost, postoperative residual calculi, and postoperative calculus recurrence were compared between the two groups. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. Survival data were analyzed using survival function. ResultsThere were significant differences in operation time, intraoperative blood loss, amount of postoperative drainage, postoperative time to recovery, and hospitalization cost between the precise liver resection group and the traditional liver resection group (t=3.720, 58.681, 19.169, 5.990, and 6.944; all P<0.05). There were no significant differences in postoperative complications including incision infection, biliary fistula, lung infection, and pleural effusion between the two groups (all P>0.05). There were also no significant differences in the incidence rates of postoperative residual calculi and calculus recurrence between the two groups (all P>0.05). The survival analysis of postoperative calculus recurrence time showed that there was no significant difference in calculus recurrence time between the two groups (P>0.05). ConclusionCompared with traditional liver resection, precise liver resection has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and faster recovery; however, precise liver resection raises hospitalization cost. Moreover, precise liver resection does not increase the risks of postoperative complications including incision infection, biliary fistula, lung infection, and pleural effusion; however, it does not reduce the incidence rates of postoperative residual calculi and calculus recurrence.
【关键字】:肝切除术;胆管,肝内;胆结石
【Key words】:hepatectomy; bile ducts, intrahepatic; cholelithiasis
【引证本文】:张生军, 刘敏丽, 常琦, 等. 精准肝切除术与传统肝切除术治疗肝内胆管结石的效果比较[J]. 临床肝胆病杂志, 2015, 31(10): 1648-1651.

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