肝切除联合纤维胆道镜治疗肝胆管结石的价值  

Treatment of hepatolithiasis by hepatectomy and choledochofiberscopy

作　　者：梁锋[1] 毕玉梅[1] 施宝民[1] 孙小刚[1] 刘志强[1] 张振海[1] 耿文茂[1] 

机构地区：[1]山东大学附属省立医院肝胆胰外科,山东济南250021

出　　处：《肝胆胰外科杂志》2010年第6期473-475,共3页Journal of Hepatopancreatobiliary Surgery

基　　金：山东省自然科学基金资助项目(Y2004C12);山东省卫生系统1020人才工程资助项目(2005.9)

摘　　要：目的评价肝切除联合纤维胆道镜治疗肝胆管结石的疗效。方法回顾性分析2005-2009年间因肝胆管结石接受外科治疗的237例临床资料,按治疗方式和分组比较其疗效。结果分析采用χ2检验。结果 5年间因肝胆管结石接受手术治疗者237例,随访210例(占88.6%),术后随访6个月至5年,平均3年6个月。肝切除组与胆道探查组的残石率、结石复发率、再手术率分别为6.3%和19.2%(χ2=6.14,P<0.05)、8.2%和23.1%(χ2=6.87,P<0.01)、7.6%和19.2%(χ2=4.48,P<0.05);使用纤维胆道镜组与未使用纤维胆道镜组的残石率、结石复发率、再手术率分别为5%和23.5%(χ2=13.3,P<0.01)、6.3%和27.5%(χ2=14.9,P<0.01)、5.7%和25.5%(χ2=14.1,P<0.01)。结论肝切除联合纤维胆道镜治疗肝胆管结石可明显提高肝胆管结石的疗效。Objective To evaluate the effect of surgical therapy for hepatolithiasis by hepatectomy and choledochofiberscopy.Methods Patients with hepatolithiasis in our hospital during 2005-2009 were retrospectively analyzed,with the comparison of the therapeutic effect of different surgical modality.Data were analyzed by chi-sqare test.Results A total of 237 patients underwent surgical treatment,210（88.6%） cases were followed-up for an average of 3 years and 6 months.In hepatectomy group and non-hepatectomy group,the residual calculus rate was 6.3% and 19.2%（X2=6.14,P0.05）,the recurrence rate of calculus was 8.2% and 23.1%（X2=6.87,P0.01）,reoperation rate was 7.6% and 19.2%（X2=4.48,P0.05）,respectively.In patients undergone choledochofiberscopy and without,the residual calculus rate was 5% and 23.5%（X2=13.3,P0.01）,the recurring rate of calculus was 6.3% and 27.5%（X2=14.9,P0.01）,reoperation rate was 5.7% and 25.5%（X2=14.1,P0.01） respectively.Conclusion Use of choledochofiberscopy in combination with hepatectomy effectively improves therapeutic efficacy of surgical treatment for hepatolithiasis.

关 键 词：胆结石 肝切除术 内窥镜 

分 类 号：R657.42[医药卫生—外科学]