保留尾状叶左半肝切除治疗左肝内胆管结石  

Treatment of left intrahepatic bile duct stones by left hemihepatectomy reserving lobus caudatus

作　　者：王宏[1] 罗建管 周健[1] 李虎山[1] 肖怀忠[1] 易旭华[1] 杨明[1] 李铎伟[1] 

机构地区：[1]湖南省浏阳市人民医院肝胆外科,浏阳410300

出　　处：《国际外科学杂志》2014年第10期685-688,F0004,共5页International Journal of Surgery

摘　　要：目的 分析左肝内胆管结石行左肝外叶切除术后结石复发的危险因素及对策.方法 回顾性分析湖南省浏阳市人民医院1998年4月-2008年8月263例因左肝内胆管结石行左肝外叶切除病例的临床资料,对出现术后结石复发患者各影响因素进行x2检验,并分析结石复发的独立危险因素.并回顾性分析2008年9月-2013年6月,对高危险因素的左肝内胆管结石患者行保留尾状叶左半肝切除后,与左肝外叶切除术后胆道镜次数进行x2检验.结果 单因素分析显示：肝脏Ⅳ段有萎缩、左肝管开口处狭窄、肝脏Ⅳ段有结石及肝脏Ⅳ段有纤维化与左肝内胆管结石行左肝外叶切除术后结石复发有关联（P =0.000）;对结石复发的高危险因素病例行保留尾状叶左半肝切除,比较两种手术方式术后胆道镜次数,发现保留尾状叶左半肝切除的手术方式能显著减少术后胆道镜次数（P=0.000）.多因素非条件Logistic回归分析结果显示：肝脏Ⅳ段萎缩、左肝管开口处狭窄和肝脏Ⅳ段结石是左肝内结石行左肝外叶切除术后,结石复发的独立危险因素（P＜0.05）.结论 肝脏Ⅳ段萎缩、左肝管开口处狭窄和肝脏Ⅳ段结石是左肝内结石行左肝外叶切除术后,结石复发的独立危险因素;保留尾状叶左半肝切除是处理这种危险因素的理想治疗方法.Objectives To analyze risk factors and therapeutic method of postoperative stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones.Methods The clinical data of 263 cases of surgery by resection of the left hepatic lobe for the left intrahepatic bile duct stones were analyzed retrospectively between April 1998 and August 2008.All influential factors were checked in chi square,and independent risk factors about postoperative stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones were analyzed.Simultaneously,times of postoperative choledochoscope were compared with chi square,about cases of left hemihepatectomy reserving lobus caudatus with high risk factors between September 2008 and June 2003 and resection of the lefi hepatic lobe for the left intrahepatic bile duct stones.Results Univariable analysis showed postoperative stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones were associated with liver atrophy of segment Ⅳ,the opening of the left hepatic duct stricture,bile duct stones in segment Ⅳ,and liver fibrosis of segment Ⅳ （P =0.000）.The surgery of left hemihepatectomy reserving lobus caudatus reduced times of postoperative choledochoscope significantly（P =0.000） campared with resection of the left hepatic lobe.liver atrophy of segment Ⅳ,the opening of the left hepatic duct stricture and bile duct stones in segment Ⅳ were independent risk factors of stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones,which was showed by multivariate unconditional Logistic regression analysis （P 〈 0.05）.Conclusions Liver atrophy of segment Ⅳ,the opening of the left hepatic duct stricture and bile duct stones in segment Ⅳ were independent risk factors of stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones.And Surgery by left hemihepatectomy reserving lobus caudatus was effectiv

关 键 词：肝切除术 胆结石 治疗应用 

分 类 号：R657.3[医药卫生—外科学]