单个医院30年2359例肝胆管结石患者临床特征的变迁  

The change in clinical presentation of patients with hepatobiliary stones： an analysis of 2 359 patients treated in a single hospital

作　　者：雷正明[1] 温剑[1] 付文广[1] 黎靖[1] 

机构地区：[1]泸州医学院附属医院肝胆外科,646000

出　　处：《中华肝胆外科杂志》2014年第2期86-88,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨肝胆管结石30年的临床变化规律.方法 以2002年为界区分前20年病例（A组）和后10年病例（B组）,回顾性对照比较2 359例患者资料.结果 B组发病年龄、病史＞10年比例、复发就诊率、肝内结石占比、合并肝硬化/门脉高压、择期手术率、T管引流、联合肝叶/段切除占比分别为（54.02±13.54）岁、68.99％、53.07％、73.18％、13.41％、80.80％、83.81％、44.74％,显著高于A组的（48.65±14.47）岁、46.25％、32.0％、62.02％、4.63％、63.92％、41.45％、19.05％（均为P＜0.01）；而胆道蛔虫患病率、并发急性重症胆管炎（ACST）、胆源性肝脓肿、胆道出血、胆道穿孔、非手术死亡率、急诊手术率、术后残石率分别为6.56％、6.15％、0.84％、0、0、1.71％、5.18％、18.70％,显著低于A组的12.11％、33.72％、1.95％、0.37％、0.67％、25.62％（均为P＜0.01）.结论 医保的普及以及复发患者的增加导致肝胆管结石住院数增加而非其发病率上升,延误治疗致病情严重化的趋势已经逆转.术中胆道镜的常规应用结合肝叶/段切除率增加有效降低了术后残石率.胆肠吻合术的应用应该严格限制.Objective To review the clinical presentation of patients with hepatobiliary stones （HS）.Method 2 359 patients with HS were divided into group A and B according to the presentation of these patients before or after 2002.Their clinical data were retrospectively analyzed.Results The age,the percentage of patients with a case history 〉 10 years,the admission rate for relapse,the intrahepatic to extrahepatic stone ratio,the number of patients complicated with liver cirrhosis/portal hypertension,the elective operation rate,the ratio of biliary drainage operation,or the ratio of biliary drainage combined with hepatic resection in group B were 54.02 ± 13.54 years,68.99%,53.07%,73.18%,13.41%,80.80%,83.81%,44.74%,respectively.The corresponding figures for group A were 48.65 ± 14.47 years,46.25%,32.0%,62.02%,4.63%,63.92%,41.45%,19.05%,all P 〈0.01.However,the rates of biliary ascariasis,acute cholangitis of severe type （ACST）,hepatic abscess,bleeding or perforation of the biliary tract,non-operative mortality,emergency operation rate and stone residual rate in group B were 6.56%,6.15%,0.84%,0,0,1.71%,5.18%,18.70%,respectively.All these were significantly lower than those in group A （12.11%,33.72%,1.95%,0.37%,0.67%,25.62%,respectively,all P 〈 0.01）.Conclusions The popularization of medical insurance and the increase in hospital admission rate,but not the actual increase in HS,led to the increase in hospitalization of patients.There was a tendency of less patients presenting with severe disease due to delay in treatment.Routine choledochoscopic stone extraction intraoperatively or postoperatively and the increased liver resection rate had decreased the residual stone rate.There should be a strict restriction on the use of choledochojejunostomy.

关 键 词：胆结石 胆道外科手术 临床特征 

分 类 号：R657.4[医药卫生—外科学]