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解剖性肝切除术治疗肝内胆管结石的效果观察
Clinical effect of anatomical hepatectomy in treatment of intrahepatic bile duct stones
文章发布日期:2016年12月07日  来源:  作者:王甸北,赵礼金,涂奎,等  点击次数:1358次  下载次数:225次

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【摘要】: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。
【Abstract】:ObjectiveTo 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 hepatectomy (anatomical hepatectomy group) and 51 underwent irregular hepatectomy (irregular hepatectomy group). The time of operation, intraoperative blood loss, volume of drainage on the day after surgery, serum levels of aspartate aminotransferase (AST), alanine aminotransferase (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 presence 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. ResultsCompared with the irregular hepatectomy group, the anatomical 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 volume 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 irregular 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). ConclusionUnder 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.
【关键字】:胆结石;肝切除术;手术后并发症;治疗结果
【Key words】:cholelithiasis; hepatectomy; post operative; treatment outcome
【引证本文】:王甸北, 赵礼金, 涂奎, 等. 解剖性肝切除术治疗肝内胆管结石的效果观察[J]. 临床肝胆病杂志, 2017, 33(1): 102-105.

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