左肝外叶切除联合胆道镜治疗肝内外胆管结石  

Left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus.

作　　者：洪勇[1] 廖文胜[1] 何阳阳[1] 

机构地区：[1]桂林医学院附属南溪山医院肝胆腺体外科,541002

出　　处：《中国综合临床》2010年第5期543-544,共2页Clinical Medicine of China

摘　　要：目的探讨左肝外叶切除联合胆道镜治疗肝内、外胆管结石的效果。方法我院1998年12月至2008年12月手术治疗的胆总管结石并左侧肝内结石患者87例，其中胆总管切开取石加左外叶切除联合术中胆道镜46例（A组），胆总管切开取石加左半肝切除41例（B组）。比较2组的术后残石率、手术并发症和远期效果。结果2组术后均无结石残余。A组术中出血量（401．1±180．4）ml和手术时间（202．5±36．6）min均明显低于B组i（515．9±200．6）ml、（257．3±42．9）min，P均〈0．01]，A组和B组术后近期优良率基本相同[91．3％（42／46）与92．7％（3／41），P〉0．05]，总的并发症发生率分别为15．2％（7／46）和24．4％（10／41），差异无统计学意义（P〉0．05）。结论肝左外叶切除联合术中胆道镜治疗左肝内胆管结石的短期和远期效果等同于左半肝叶切除，且有缩短住院时间、减轻患者经济负担等优点。Objective To investigate the effect of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus. Methods Eighty-seven patients with hepatobiliary calculus who underwent hepatectomy from December, 1998 to December,2008 were reviewed retrospectively. Forty-six patients underwent the section of common bile duct to remove calculus combined with left lateral segmentectomy and fiber choledochoscope（ Group A）,41 patients underwent left hepatectomy and section of common bile duct to remove calculus（ Group B）. The postoperative stone residual rate, complications and long-term outcome were compared between the two groups. Results The postoperative stone residual rate of either group was zero. Intraoperative bleeding （ 401.1 ±180.4ml） ,operative times （ 202. 5 ±36. 6 min） of group A were significantly lower than those of the group B （ 515.9± 200. 6ml and 257.3± 42. 9min） （ P 〈 0. 001 and 0. 01, respectively ） . Hospital stays of group A was lower than that of group B, but this is no statistical significance （ P 〉 0. 05 ） . The incidence of postoperative complications were similar in the two groups（ 15.2% v. s. 24.4% ,P 〉 0. 05 ）. The effective rates of the two groups were similar （ 91.3 % VS 92. 7 % , P 〉 0. 05 ）. Conclusions The long-term and short-term outcome of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus is similar to that of left hepatectomy , and can successfully shorten the hospital stay and reduce the hospital fee.

关 键 词：肝内胆管结石 肝切除术 胆道镜 

分 类 号：R657.4[医药卫生—外科学]