双侧规则性肝段或肝叶切除术治疗复杂性肝内胆管结石  

Bilateral Anatomic Segmentectomy/Sectionectomy for Complicated Intrahepatic Stones

作　　者：李绍强[1] 梁力建[1] 华赟鹏[1] 彭宝岗[1] 付顺军[1] 

机构地区：[1]中山大学附属第一医院肝胆外科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2009年第6期780-783,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(7001626)

摘　　要：【目的】探讨双侧规则性肝段或肝叶切除术治疗复杂性肝内胆管结石的短期和远期效果。【方法】回顾性分析我院近10年来行左右双侧规则性肝段/叶切除术治疗复杂性肝内胆管结石的101例患者,分析其短期和远期效果。Cox风险比例模型分析影响结石术后复发的危险因素。【结果】本组病例无手术死亡,术后并发症发生率为28.7%。肝切除术后结石清除率为84.2%(85/101),经术后胆道镜取石,最终的结石清除率为95.0%(95/101)。结石复发率为7.9%,术后胆管炎发生率为6.5%(中位随访时间为54个月)。Cox风险比例模型结果显示肝切除范围<结石分布的范围是结石术后复发的独立危险因素:P=0.015,危险度(OR)=2.152,95%可信区间(CI):1.624～4.721。【结论】双侧规则性肝段/叶切除术治疗复杂性肝内胆管结石是安全的,术后短期和远期效果良好,肝切除的范围是影响术后结石复发的独立危险因素。[Objective] To evaluate the short-term and long-term outcomes of bilateral segmentectomy/sectionectomy for complicated intrahepatic stones. [Methods] A total of 101 consecutive patients with intrahepatic stones who underwent bilateral segmentectomy/sectioneetomy in past 10 years were reviewed retrospectively. The short-term and long-term outcomes of the patients were analyzed. And Cox regression mode was used to identify the risk factors related to stone recurrence. [Results] There was no surgical mortality in this group of patients. The surgical morbidity was 28.7%. Stone clearance rate after hepatectomy was 84.2% and final clearance rate was 95.0% following postoperative eholedochoscopic lithotripsy. The stone recurrence rate was 7.9% and postoperative cholangitis episodes was 6.5% in median follow-up period of 54 months. The Cox regression model indicated that liver resection range less than the range of stone distribution （P = 0.015, Odd ratio = 2.152） was the independent risk factor linked to stone recurrence. [Conclusions] bilateral segmentectomy/sectionectomy is safe for patients with intrahepatic stone, and its short-term and long-term outcomes are satisfactory. Liver resection range less than the range of stone distribution is the risk factor associated with stone recurrence.

关 键 词：肝内胆管结石 肝切除术 双侧 效果 

分 类 号：R6[医药卫生—外科学]