磁共振对比肝切除与胆总管切开取石术治疗肝胆管结石的远期疗效  

MRI to compare the long-term outcomes of partial hepatectomy versus choledocholithotomy in the treatment of hepatolithiasis

作　　者：陈阳[1] 余小舫[1] 鲍世韵[1] 孙枫林[1] 张卓[1] 马扬[1] 

机构地区：[1]暨南大学第二临床医学院民医院肝胆胰外科,深圳518020

出　　处：《中华肝胆外科杂志》2015年第7期442-444,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的比较规则性肝叶切除术与胆总管切开取石术两者联合术中及术后胆道镜治疗肝胆管结石病的远期疗效。方法回访完成上述两类术式的肝胆管结石病例并复查肝胆磁共振（增强MRI＋MRCP），对比两组异常影像学表现发生率。结果成功回访268例患者，其中规则性肝叶切除为主的联合手术138例，胆总管切开取石为主的联合手术130例。对比分析显示肝切除组多个指标显著优于取石组，两组差异具有统计学意义。急性胆管炎并结石复发率（5．8％比21．5％），再手术率（5．8％比21．5％），胆管狭窄率（8．0％比44．6％），肝实质异常灌注率（4．3％比23．1％），肝内胆管增强／增厚发生率（1．5％比26．9％），肝段萎缩发生率（3．0％比30．0％），胆管癌发生率（0比2．3％）。结论因没有去除病灶，胆总管切开取石联合胆道镜术后远期不良事件发生率较肝切除组高，前者应视为切肝术的重要补充。Objective To compare the long-term outcomes of partial hepatectomy versus choledo- cholithotomy both combined with choledoehoscopy, for the treatment of hepatolithiasis. Methods Patients who underwent either type of the operations were followed up and examined using hepatobiliary magnetic re- sonance （enhanced MRI ＋ MRCP）. The incidences of abnormal imaging in the two groups were compared. Results Of 268 patients, 138 patients underwent partial hepatectomy and the remaining 130 patients under- went choledocholithotomy. When hepatectomy was compared with eholedoeholithotomy, the recurrence rate of acute cholangitis combined with bile duct stone （5.8%o vs. 21.5% ）, the reoperation rate （5.8% vs. 21.5% ）, the bile duct stricture rate （8.0% vs. 44. 6% ）, the abnormal liver parenchyma perfusion rate （4.3% vs. 23.1% ）, the incidence of intrahepatic bile duct enhancement or thickening （1.5% vs. 26. 9% ）, the incidence of hepatic atrophy （3.0% vs. 30.0% ） and the incidence of cholangiocarcinoma （0 vs. 2. 3% ） were better. Conclusions The long-term adverse outcomes were significantly worse in the cho- ledocholithotomy group than in the partial hepatectomy group. Choledocholithotomy combined with choledo- choscopy should only be considered as a complementary procedure to partial hepatectomy in hepatolithiasis.

关 键 词：肝胆管结石病 胆道镜 规则性肝切除术 磁共振成像 磁共振胰胆管造影 

分 类 号：R657.42[医药卫生—外科学]