解剖性肝切除术治疗复杂肝内胆管结石体会

摘要

Objective To discuss the value of anatomic hepatectomy in the treatment of complicated intrahepatic bile duct stones.Methods The clinical data of 98 patients with complicated intrahepatic bile duct stones undergoing hepatectomy were retrospectively analyzed in our hospital from January 2012 to March 2017.Among them,51 cases were given anatomical liver resection,and 47 cases received non-anatomical liver resection.The blood loss,operation time,recovery of liver function,hospital stay,postoperative complications,postoperative residual stone rate and recurrence rate of the two kinds of operations were compared.The curative efficacy of two operations was also compared.Results There was significant difference intraoperative bleeding,postoperative complications,postoperative residual stone rate and the recurrence rate between Anatomical liver resection group and nonanatomical liver resection.However,there was no significant difference in operation time,liver function recovery and hospitalization time between two groups.Conclusions Anatomical hepatectomy for complex intrahepatic bile duct stones has advantages of less bleeding,less postoperative complications,less residual stone rate and lower recurrence rate.It is an alternative surgical procedure.%目的 探讨解剖性肝切除术治疗复杂肝内胆管结石的价值.方法 回顾性分析2012年1月至2017年3月行肝切除术的98例复杂肝内胆管结石病人的临床资料,男性42例,女性56例,年龄28～69岁,平均47.2岁.其中行解剖性肝切除术51例(AR组),非解剖性肝切除术47例(NAR组).对比两种手术方式病人的术中出血量、手术时间、肝功能恢复情况、住院时间、术后并发症、术后残石率和结石复发率.比较两种手术方式的治疗效果.结果 AR组病人术中出血量为(466.0±52.1) ml、术后并发症8例(17.65％)、术后残石率为0和结石复发1例(2.04％),明显优于NAR组的(741.0±46.3)ml、15例(29.79％)、3例(6.67％)和4例(8.89％).而手术时间、肝功能恢复情况、住院时间差异均无统计学意义.术后2个月至5年获随访94例,其中AR组49例,NAR组45例,失访4例.均行B超、CT、MRCP等检查,AR组无结石残留,术后胆总管结石复发1例,行内镜下十二脂肠乳头括约肌切开术(EST)取石治愈.NAR组结石残留3例,结石复发4例.在术后8个月至3年内再次行解剖性肝叶肝段切除3例,1例行EST取石成功,1例长期服用熊去氧胆酸等药物治疗未手术,另2例因经济原因放弃治疗.结论 解剖性肝切除术治疗复杂肝内胆管结石,具有术中出血少、术后并发症少、术后残石率和复发率低的优势,是一种可选择的手术方式.