CAJ | 학술논문

目的探讨肝部分切除联合囊肿广泛开窗术治疗严重成人多囊肝病的手术效果及临床分型对预后的评估作用.方法回顾性分析采用肝部分切除联合囊肿广泛开窗术治疗的33例严重成人多囊肝病患者的术前症状、体征,及术后并发症和预后.根据影像学检查所显示的囊肿位置、数量以及残存的肝脏组织将严重成人多囊肝分为A、B两型,每型又分为Ⅰ、Ⅱ、Ⅲ3级,比较两型患者术后并发症发生情况.并发症发生频次比较采用四格表χ~2检验.结果 33例患者均治愈出院,平均随访时间为57个月,3例(9.1%)患者分别于术后第43、68、81个月症状再发;2例患者分别于术后第85、[37个月死于肾功能衰竭;1例患者术后发生肝功能不全.术后8个月接受肝移植治疗.术后共26例患者出现并发症,并发症发生率为78.8%,其中包括出血1例、胆漏2例、少量腹水14例、大量腹水12例、胸腔积液18例.有影像学资料随访的22例患者中,A型患者6例,B型16例,术后并发症发生的频次分别为4次和31次,差异有统计学意义(χ~2=4.99,P<0.05).结论肝部分切除联合肝囊肿广泛开窗是治疗严重成人多囊肝病的一种理想的治疗方式,尽管术后并发症发生率高,但整体预后良好,分型可对患者术后并发症进行评估.
목적 탐토간부분절제연합낭종엄범개창술치료엄중성인다낭간병적수술효과급림상분형대예후적평고작용.방법 회고성분석채용간부분절제연합낭종엄범개창술치료적33례엄중성인다낭간병환자적술전증상、체정,급술후병발증화예후.근거영상학검사소현시적낭종위치、수량이급잔존적간장조직장엄중성인다낭간분위A、B량형,매형우분위Ⅰ、Ⅱ、Ⅲ3급,비교량형환자술후병발증발생정황.병발증발생빈차비교채용사격표χ~2검험.결과 33례환자균치유출원,평균수방시간위57개월,3례(9.1%)환자분별우술후제43、68、81개월증상재발;2례환자분별우술후제85、[37개월사우신공능쇠갈;1례환자술후발생간공능불전.술후8개월접수간이식치료.술후공26례환자출현병발증,병발증발생솔위78.8%,기중포괄출혈1례、담루2례、소량복수14례、대량복수12례、흉강적액18례.유영상학자료수방적22례환자중,A형환자6례,B형16례,술후병발증발생적빈차분별위4차화31차,차이유통계학의의(χ~2=4.99,P<0.05).결론 간부분절제연합간낭종엄범개창시치료엄중성인다낭간병적일충이상적치료방식,진관술후병발증발생솔고,단정체예후량호,분형가대환자술후병발증진행평고.
Objective To evaluate therapeutical effect of combined hepatic resection and fenestra-tion on patients with severe adult polycyst liver disease (APLD). Methods Preoperative clinical symptoms, postoperative complications and prognosises from 33 patients with severe adult polycyst liver disease (APLD) treated with combined hepatic resection and fenestration were recorded. According to the number and loca-tion of cysts before surgery and the remnant liver parenchyma after operation, all patients were classified into two types: class A and B. And patients in each type were further classified into three grades: Grade Ⅰ,Ⅱ and Ⅲ. The frequency of postoperative complications of two types patients was compared. Results The mean follow-up time was 57 months. There were three patients with recurrence of symptoms at 81, 68 and 43 mouths after operation. Two patients died of renal failure due to polycystic kidney disease at 137 and 85 mouths after operation. And one patient with postoperative hepatic inadequacy recieved an orthotopic liver transplantation. The total number of patients with postoperative complications was 26 cases, including one patient with bleeding, two patients with bile leakage, fourteen patients with mild ascites, twelve patients with severe ascites and eighteen patients with pleural effusion, and the overall incidence was 78.8%. There were 22 patients with imaging data, including 6 patients within A type and sixteen patients within B type. The frequencies of postoperative complications were 4 and 31,respectively, and the difference was statistically significant (χ~2 = 4.99, P < 0.05). Conclusions Combined hepatic resection and fenestration is a safe and acceptable procedure for the treatment of severe APLD.