不同手术方式治疗肝内胆管结石的疗效评价  

Therapeutic evaluation of different surgical methods in the treatment of hepatolith

作　　者：胥丹[1,2] 姜淮芜[2] 安志明[2] 

机构地区：[1]西南医科大学,四川泸州646000 [2]四川绵阳404医院

出　　处：《中西医结合肝病杂志》2016年第2期86-88,共3页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨胆总管空肠Roux-en-Y吻合术、高位胆管切开取石+T管引流术、肝叶(段)切除+T管引流术3种不同手术方式治疗肝内胆管结石的临床治疗效果。方法:292例患者为四川绵阳404医院2003年1月至2013年6月确诊为肝内胆管结石的患者,其中胆总管空肠Roux-en-Y吻合术组48例,高位胆管切开取石+T管引流术组106例,肝叶(段)切除+T管引流术组138例,收集并比较3组患者术前、术中及术后的资料,并对纳入研究病例进行两年随访。结果:肝叶(段)切除+T管引流术组的结石残存率低于其他两组,差异具有统计学意义(P<0.05);肝叶(段)切除+T管引流术组取净肝内胆结石率高于其他两组,结石复发率低于其他两组。胆管炎复发率低于其他两组(P均<0.05);肝叶(段)切除+T管引流术、胆总管空肠Roux-en-Y吻合术、胆总管切开取石+T管引流术的并发症发生率分别为31.88%、25.00%、18.87%,差异有显著性意义(P<0.05)。结论:肝叶(段)切除+T管引流术可降低结石的残存率和结石复发率,但是其并发症发生率高于其他两组。由于肝内结石的成因及病理情况较为复杂,应根据病人具体情况具体分析,以采用适当的手术方式取得更好的临床疗效。Objective：To investigate the effect of different surgical methods on hepatolith in patients.Methods：292 cases of hepatolithiasis were included in Mianyang 404 Hospital from January 2003 to June 2013.The number of common bile duct jejunum Roux-en-Y anastomosis was 48 cases,high bile duct cut stone ＋ T tube drainage was 106 cases,lobe（segment） resection ＋ T tube drainage group wasl38 cases.3 groups of patients were collected and compared before surgery,intraoperative and postoperative and 2 year follow-up study was carried out.Results：The residual stone rate,Stone recurrence rate and cholangitis recurrence rate in the lobe（segment） resection ＋ T tube drainage group were lower than the other two groups,the difference were statistically significant（P〈0.05）,while incidence of gallstones in liver were higher than the other two groups（P〈0.05）;But lobe（segment） resection ＋ T tube drainage,bile duct jejunum Roux-en-Y anastomosis and choledocholithotomy ＋ T tube drainage complication rates were 31.88%,25.00%,18.87%respectively,the difference was statistically significant{P〈0.05）.Conclusion;The lobe（segment） resection ＋ T-tube drainage could reduce the.residual rate and recurrence rate,but the complication rate is higher than the other two groups.Since the causes of intrahepatic stones and pathological situation are complex,specific analysis should be made in order to achieve better clinical efficacy with appropriate surgical procedures.

关 键 词：胆总管空肠ROUX-EN-Y吻合术 高位胆管切开取石+T管引流术 肝叶(段)切除+T管引流术 肝内胆管结石 

分 类 号：R657.42[医药卫生—外科学]