精准肝切开取石联合球囊扩张治疗右肝段胆管狭窄伴结石临床研究  

Clinical study on treatment of right hepatic biliary stenosis and stone with precision liver lithotomy and combined balloon dilatation

作　　者：沈志宏[1] 冯刚[1] 鲁葆春[1] 郑军 邵惠江[1] SHEN Zhihong;FENG Gang;LU Baochun(Shaoxing People＇s Hospital, Zhejiang 312000, China)

机构地区：[1]浙江省绍兴市人民医院,绍兴312000 [2]浙江省诸暨市人民医院

出　　处：《浙江创伤外科》2018年第3期417-419,共3页Zhejiang Journal of Traumatic Surgery

基　　金：浙江省医药卫生科技计划立项项目<精准肝切开取石联合球囊扩张治疗右肝段胆管狭窄伴结石临床研究>(编号:2015KYA218)

摘　　要：目的对右肝段胆管狭窄伴结石患者进行精准肝切开取石联合球囊扩张治疗,探讨其临床疗效。方法选取2013年1月至2017年1月绍兴市人民院及诸暨市人民医院收治的右肝段胆管狭窄伴结石患者30例,对其进行精准肝切开取石联合球囊扩张治疗,将其作为研究组,另选取同期医院收治的行肝叶切除治疗的右肝段胆管狭窄伴结石患者30例,将其作为对照组,术后对两组患者手术相关情况、肝功能、术后并发症及结石复发情况进行观察比较。结果与对照组比较,研究组患者术中出血量、术后住院时间及术后并发症发生率均明显降低,差异具有统计学意义(P<0.05);在肝功能各指标(谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL))水平方面,两组患者术后均降低至正常水平,与治疗前比较均具有统计学意义(P<0.05);对两组患者进行1年时间随访,研究组术后结石复发率3.3%与对照组结石复发率26.7%比较明显降低,差异具有统计学意义(P<0.05)。结论对右肝段胆管狭窄伴结石患者进行精准肝切开取石联合球囊扩张治疗能够取得良好临床效果,可使术后并发症及结石复发率显著降低,预后良好,具有微创、安全、有效等优势,值得临床进一步推广应用。Objective To evaluate the clinical effect of precise hepatotomy and stone extraction combined with balloon dilation in patients with right hepatic bile duct stenosis and stones. Methods From January 2013 to January 2017, 30 patients with right hepatic bile duct stenosis and stones treated inthe hospital were selected. As study group, they were treated with precision hepatotomy and stone extraction combined with bal-loon dilatation.At the same period,30 patients with right hepatic bile duct stenosis were selected as control group, treated with hepatectomy. Postoper-atively, the operation-related conditions, liver function, postoperative complications, and stone recurrence were compared between the two groups.Results Compared with the control group, the intraoperative blood loss, postoperative hospital stay, and postoperative complications rate in the study group were all significantly lower（P〈0.05）. The liver function indicators（AST, ALT, TBIL） in theboth groups were reduced to normal levels after surgery, and therewere statistically significant difference（P〈0.05）.All patients intwogroups were followed up for one year. The recurrence rate of stone after surgery in the study group was 3.3%, which was lower than that of the control group（26.7%）, and the difference was statistically significant（ P〈0.05）. Conclusion Patients with right hepatic biliary stenosis and calculustreated with accurate hepatotomy and stone dilatation combined with balloon dilatation,can achieve good clinical results, can significantly reduce the postoperative complications and recurrence rate of stones, and have a good prognosis with minimal invasion and safety, and it is worth further promotion and application of the clinical.

关 键 词：精准肝切开取石 球囊扩张 胆管狭窄 结石 临床疗效 

分 类 号：R657.3[医药卫生—外科学]