肝部分切除联合囊肿广泛开窗术治疗严重成人多囊肝病的疗效及临床分型对其预后的影响  

Therapeutical effect of combined hepatic resection and fenestration on patients with severe adult polycyst liver disease

作　　者：陈威[1] 张海斌[1] 付雍[1] 司马辉[1] 杨宁[1] 杨广顺[1] 

机构地区：[1]第二军医大学附属东方肝月甘外科医院胆道二科,上海200438

出　　处：《中华肝脏病杂志》2010年第1期41-44,共4页Chinese Journal of Hepatology

摘　　要：目的 探讨肝部分切除联合囊肿广泛开窗术治疗严重成人多囊肝病的手术效果及临床分型对预后的评估作用。方法回顾性分析采用肝部分切除联合囊肿广泛开窗术治疗的33例严重成人多囊肝病患者的术前症状、体征，及术后并发症和预后。根据影像学检查所显示的囊肿位置、数量以及残存的肝脏组织将严重成人多囊肝分为A、B两型，每型又分为Ⅰ、Ⅱ、Ⅲ3级，比较两型患者术后并发症发生情况。并发症发生频次比较采用四格表x^2检验。结果33例患者均治愈出院，平均随访时间为57个月，3例（9．1％）患者分别于术后第43、68、81个月症状再发；2例患者分别于术后第85、137个月死于肾功能衰竭；1例患者术后发生肝功能不全，术后8个月接受肝移植治疗。术后共26例患者出现并发症，并发症发生率为78．8％，其中包括出血1例、胆漏2例、少量腹水14例、大量腹水12例、胸腔积液18例。有影像学资料随访的22例患者中，A型患者6例，B型16例，术后并发症发生的频次分别为4次和31次，差异有统计学意义（x^2=4．99，P〈0．05）。结论肝部分切除联合肝囊肿广泛开窗是治疗严重成人多囊肝病的一种理想的治疗方式，尽管术后并发症发生率高，但整体预后良好；分型可对患者术后并发症进行评估。Objective To evaluate therapeutical effect of combined hepatic resection and fenestration on patients with severe adult polycyst liver disease （APLD）. Methods Preoperative clinical symptoms, postoperative complications and prognosises from 33 patients with severe adult polycyst liver disease （APLD） treated with combined hepatic resection and fenestration were recorded. According to the number and location of cysts before surgery and the remnant liver parenchyma after operation, all patients were classified into two types： class A and B. And patients in each type were further classified into three grades： Grade Ⅰ, Ⅱ and Ⅲ. The frequency of postoperative complications of two types patients was compared. Results The mean follow-up time was 57 months. There were three patients with recurrence of symptoms at 81, 68 and 43 mouths after operation. Two patients died of renal failure due to polycystic kidney disease at 137 and 85 mouths after operation. And one patient with postoperative hepatic inadequacy recieved an orthotopic liver transplantation. The total number of patients with postoperative complications was 26 cases, including one patient with bleeding, two patients with bile leakage, fourteen patients with mild ascites, twelve patients with severe ascites and eighteen patients with pleural effusion, and the overall incidence was 78.8%. There were 22 patients with imaging data, including 6 patients within A type and sixteen patients within B type. The frequencies of postoperative complications were 4 and 31 ,respectively, and the difference was statistically significant （ x 2 = 4.99, P 〈 0.05）. Conclusions Combined hepatic resection and fenestration is a safe and acceptable procedure for the treatment of severe APLD.

关 键 词：肝切除术 开窗术 预后 分型 成人多囊肝病 

分 类 号：R473.6[医药卫生—护理学]