CAJ | 학술논문

目的：探讨解剖性左半肝切除治疗左肝内胆管结石的可行性与安全性。方法将80例左肝胆管结石拟行半肝切除术的患者随机分为治疗组和对照组，每组各40例。治疗组采用解剖性左半肝切除，对照组采用Pringle法全肝入肝血流阻断左半肝切除。比较分析两组手术时间、术中出血量、术后肝功能恢复及术后并发症发生情况。结果两组手术时间、术中出血量、术中输血量均无统计学差异（P＞0.05），而治疗组术后住院时间较对照组明显缩短（P＜0.05）；术后5 d，治疗组谷丙转氨酶（ALT）、谷草转氨酶（AST）及总胆红素（TB）水平均显著低于对照组（P＜0.05）。术后1 d、3 d，治疗组术后凝血活酶时间（APTT）、凝血酶原时间（PT）均显著低于对照组（P＜0.05），而术后5 d 上述凝血指标在两组间无统计学差异（P＞0.05）；治疗组术后并发症发生率为10.0%，显著低于对照组（25.0%，P＜0.05）。结论解剖性左半肝切除是安全可行的，对健侧肝脏损伤较小，可有效控制术中出血，减少术后并发症，是左肝内胆管结石的一种理想治疗方法。
목적：탐토해부성좌반간절제치료좌간내담관결석적가행성여안전성。방법장80례좌간담관결석의행반간절제술적환자수궤분위치료조화대조조，매조각40례。치료조채용해부성좌반간절제，대조조채용Pringle법전간입간혈류조단좌반간절제。비교분석량조수술시간、술중출혈량、술후간공능회복급술후병발증발생정황。결과량조수술시간、술중출혈량、술중수혈량균무통계학차이（P＞0.05），이치료조술후주원시간교대조조명현축단（P＜0.05）；술후5 d，치료조곡병전안매（ALT）、곡초전안매（AST）급총담홍소（TB）수평균현저저우대조조（P＜0.05）。술후1 d、3 d，치료조술후응혈활매시간（APTT）、응혈매원시간（PT）균현저저우대조조（P＜0.05），이술후5 d 상술응혈지표재량조간무통계학차이（P＞0.05）；치료조술후병발증발생솔위10.0%，현저저우대조조（25.0%，P＜0.05）。결론해부성좌반간절제시안전가행적，대건측간장손상교소，가유효공제술중출혈，감소술후병발증，시좌간내담관결석적일충이상치료방법。
Objective To explore feasibility and safety of anatomical left semi-hepatectomy in the treatment of left segment bile duct stone. Methods 80 patients with left segment bile duct stone undergoing elective semi-hepatectomy were randomly divided into two groups, including 40 cases of treatment group, 40 cases of control group. The treatment group was treated with anatomical left semi-hepatectomy, and the control group was treated with left semi-hepatectomy by pringle’s maneuver. The operation time, blood loss in operation, improvement of liver function after operation and complications after operation were compared. Results There were no significant difference on the operation time, blood loss and blood transfusions in operation (P>0.05), while the stay-in-hospital time after operation in treatment group was significantly shorter than that in control group (P<0.05).After treatment for 5 days, the level of ALT, AST and TB in treatment group were significantly lower than those in control group (P<0.05). For 5 days, the PT, APTT in treatment group at 1st and 3rd after treatment were significantly shorter than those in control group (P<0.05), while the difference was no longer significant at 5th after treatment(P>0.05).The incidence of post-operative complications in treatment group was 10.0%, and 25.0% in control group, the difference was significant (P<0.05). Conclusions It is a safe and feasible of anatomical left semi-hepatectomy for treating left segment bile duct stone, it has relative small damage to liver of uninjured sides, and it can contribute to control blood loss in operation, reduce post-operative complications.