肝段（叶）切除胆肠Roux—en—Y吻合加联合抗反流装置治疗肝内胆管结石的治疗效果研究  

Therapeutic effects of hepatectomy plus Roux-en-Y choledochojejunostomy in combination with reflux prevention on intrahepatic bile duct stone

作　　者：金晓波[1] 周连帮 王文擘[1] 王小军[1] 杨越涛[3] 钟准[3] 

机构地区：[1]宁波大学医学院附属医院肝胆外科,浙江315020 [2]宁波市鄞州二院肝胆外科 [3]丽水市人民医院肝胆外科,浙江323000

出　　处：《中华肝胆外科杂志》2010年第1期26-29,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：本课题受浙江省卫生厅医学科研基金资助（基金编号2003A080）

摘　　要：目的探讨肝段（叶）切除胆肠Roux-en-吻合加联合抗反流装置治疗肝内胆管结石的治疗效果。方法肝内胆管结石病人230例，其中行肝段（叶）切除联合胆肠Roux-en—Y吻合附加抗反流装置病例103例；行胆总管切开取石、胆总管十二指肠吻合术28例；肝门胆管切开取石、胆管空肠Roux-en—Y吻合术74例；肝总管切开取石、T形管引流术25例。随访时间8～18年。观察手术后近期胸腔积液、切口感染、胆漏、手术后残余结石并发症以及评价远期的治疗效果与结石复发率。结果各组间胸腔积液、切口感染、胆漏并发症比较无显著性差异（P=0．923）。与其他组比较，肝段（叶）切除联合胆肠Roux-en-Y吻合附加抗反流装置组的残余结石率显著性降低（P=0．00），一次取净率有显著性增高（P=0．00），治疗效果显著性提高（P=0．00），结石复发率显著性降低（P=0．00）。结论肝段（叶）切除胆肠Roux-en—Y吻合加联合抗反流对肝内胆管结石具有良好的治疗效果。Objective To investigate the therapeutic effects of hepatic resection plus Roux-en Y choledochojejunostomy in combination with reflux prevention on intrahepatic bile duct stone. Methods The clinical data of 230 patients with intrahepaticbile duct stone surgically treated in our hospital in the past 18 years were retrospectively analyzed. Of the 230 patiets, 110 underwent hepatectomy plus Roux-en-Y choledochojejunostgmy in combination with reflux prevention and the others received other surgeries. The complications of pleural effusions, infection of incisional wound, leakage of bile and retained calculus after operation were studied. Meanwhile, the recurrent rate of stone and long-term effects were determined. Results The occurrinjg rate of pleural effusion, infection of incision wound, leakage of bile was not significantly different among different groups. However, the retained calculus and recurrent rate of stone in the group of patients underwent hepatectomy plus Roux-en-Y choledo- chojejunostomy in combination with reflux prevention were significantly decreased as compared with other group （P〈0.05）. So was the effect in long term （P〈0.05）. Conclusion Hepatectomy plus Roux-en-Y choledochojejunostomy in combination with reflux prevention could have better effect on patients with intrahepatic bile duct stone.

关 键 词：肝切除术 抗反流 肝内胆管结石 胆肠吻合 

分 类 号：R657.4[医药卫生—外科学]