两种方法治疗有胆道手术史的左肝管结石患者的疗效比较  

Comparison of the clinical effect of two methods in the treatment of left hepatic duct stones with a history of biliary surgery

作　　者：高庆轮 张恺 俎雪玲 GAO Qinglun;ZHANG Kai;ZU Xueling(Department of Hepatobiliary Surgery,Shandong Provincial Third Hospital,Jinan,Shandong 250000,China;Department of Pharmacy,Shandong Provincial Third Hospital,Jinan,Shandong 250000,China;Department of Anesthesiology,Shandong Provincial Third Hospital,Jinan,Shandong 250000,China)

机构地区：[1]山东省立第三医院肝胆外科,山东济南250000 [2]山东省立第三医院药剂科,山东济南250000 [3]山东省立第三医院麻醉科,山东济南250000

出　　处：《检验医学与临床》2020年第17期2497-2499,2503,共4页Laboratory Medicine and Clinic

摘　　要：目的比较和分析腹腔镜左肝外叶切除经左肝管断端或经胆总管探查胆道这两种方法治疗有胆道手术史的左肝管结石患者的临床疗效。方法回顾性分析2014年10月至2017年9月该院76例有胆道手术史的左肝外叶胆管结石患者的临床资料。其中,腹腔镜左肝外叶切除经左肝管断端胆道探查取石术40例(LHD组),腹腔镜左肝外叶切除经胆总管胆道探查取石术36例(CBD组)。比较两组肝切除术式的比例、胆管探查时间、整体手术时间、术中出血量、短期并发症发生率、结石残留情况、平均住院时间、术后结石复发率,长期并发症发生率。结果两组均有1例中转开腹术,两组均无结石残留,围术期无死亡病例。两组患者的肝切除术式的比例、胆管探查时间、平均住院时间、术后结石复发率和长期并发症比较,差异均无统计学意义(P>0.05)。LHD组整体手术时间短于CBD组,术中出血量少于CBD组,短期并发症发生率低于CBD组,差异均有统计学意义(P<0.05)。结论在术前充分的准备评估下,对于有胆道手术史的左肝胆管结石患者,腹腔镜下左肝外叶切除经左肝管断端行胆道探查取石术简化了手术步骤,具有创伤小、恢复快和并发症发生率低等优点。Objective To compare and analyze the clinical effect of laparoscopic left extrahepatic lobectomy through the broken end of the left hepatic duct or through common bile duct for exploration of biliary tract in the treatment of left intrahepatic cholelithiasis patients with a history of biliary operation.Methods The clinical data of 76 patients with choledocholithiasis in the left lateral lobe with a history of biliary operation from October 2014 to September 2017 were analyzed retrospectively.Among them,40 patients(LHD group)underwent laparoscopic left extrahepatic lobectomy and choledocholithotomy through left hepatic duct stump for exploration of biliary tract,36 patients(CBD group)underwent laparoscopic left lateral hepatectomy through common bile duct for exploration of biliary tract.The indexes of hepatectomy,bile duct exploration time,overall operation time,intraoperative bleeding volume,short-term complications,stone residue,average hospitalization time,stone recurrence rate and long-term complications were compared between the two groups.Results In both groups,there was one case of abdominal operation,and there was no death in perioperative period.There was no significant difference between the two groups in hepatectomy and common bile duct exploration time,average hospitalization time,reccurrence rate of postoperative calculi and long-term complication rate(P>0.05).The overall operation time in LHD group was shorter than that in CBD group,intraoperative hemorrhage was less than that in CBD group,short-term complication rate was lower than that in CBD group,and the differences were statistically significant(P<0.05).There was no stone residue in both groups,the stone recurrence rate in CBD group was also higher than those in LHD group,and the difference was statistically significant(P<0.05).Conclusion With sufficient preparation and evaluation before operation,for left intrahepatic cholelithiasis patients with a history of biliary operation,laparoscopic exploration and extraction of choledocholithiasis thro

关 键 词：胆道手术史 左肝内结石 胆总管探查 左肝管残端探查 

分 类 号：R575[医药卫生—消化系统]