中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
11期
822-825
,共4页
胆结石%肝切除术%胆管肠吻合术,肝
膽結石%肝切除術%膽管腸吻閤術,肝
담결석%간절제술%담관장문합술,간
Cholelithiasis%Hepatectomy%Portoenterostomy
目的 探讨肝内胆管结石外科治疗术式及效果.方法 回顾性分析总结我院近3年择期手术治疗的176例肝内胆管结石患者的术后近期残石率、围手术期并发症及术后远期疗效.肝内胆管结石分型:Ⅰ型45例,Ⅱa型25例,Ⅱb型25例,Ⅱc型3例,Ea型52例,Eb型19例,Ee型7例.手术方式:胆道探查取石+T管引流术71例(Ea型31例,Ⅰ型15例,Ⅱa型25例);胆道探查+胆肠吻合术25例(Ea型14例,Eb型7例,Ec型4例);胆道探查+肝胆管空肠盆式吻合术10例(Ⅱb型5例,Ⅱc型3例,Ea型2例);肝段(叶)切除+外或内引流术70例(Ⅰ型30例,Ⅱb型20例,Ea型5例,Eb型12例,Ec型3例).结果 肝切除组术后近期残石率、术后远期疗效均优于非肝切除术组[17.1％(12/70)对43.4％(46/106),91.4％(53/58)对77.0％(67/87)],但围手术期并发症发生率高于非肝切除术组[37.1％(26/70)对14.2％(15/106)].结论 肝切除是Ⅰ型、Ⅱb型肝内胆管结石患者的首选术式,肝门部胆管空肠盆式吻合术是Ⅱc型肝内胆管结石患者的主要术式.
目的 探討肝內膽管結石外科治療術式及效果.方法 迴顧性分析總結我院近3年擇期手術治療的176例肝內膽管結石患者的術後近期殘石率、圍手術期併髮癥及術後遠期療效.肝內膽管結石分型:Ⅰ型45例,Ⅱa型25例,Ⅱb型25例,Ⅱc型3例,Ea型52例,Eb型19例,Ee型7例.手術方式:膽道探查取石+T管引流術71例(Ea型31例,Ⅰ型15例,Ⅱa型25例);膽道探查+膽腸吻閤術25例(Ea型14例,Eb型7例,Ec型4例);膽道探查+肝膽管空腸盆式吻閤術10例(Ⅱb型5例,Ⅱc型3例,Ea型2例);肝段(葉)切除+外或內引流術70例(Ⅰ型30例,Ⅱb型20例,Ea型5例,Eb型12例,Ec型3例).結果 肝切除組術後近期殘石率、術後遠期療效均優于非肝切除術組[17.1％(12/70)對43.4％(46/106),91.4％(53/58)對77.0％(67/87)],但圍手術期併髮癥髮生率高于非肝切除術組[37.1％(26/70)對14.2％(15/106)].結論 肝切除是Ⅰ型、Ⅱb型肝內膽管結石患者的首選術式,肝門部膽管空腸盆式吻閤術是Ⅱc型肝內膽管結石患者的主要術式.
목적 탐토간내담관결석외과치료술식급효과.방법 회고성분석총결아원근3년택기수술치료적176례간내담관결석환자적술후근기잔석솔、위수술기병발증급술후원기료효.간내담관결석분형:Ⅰ형45례,Ⅱa형25례,Ⅱb형25례,Ⅱc형3례,Ea형52례,Eb형19례,Ee형7례.수술방식:담도탐사취석+T관인류술71례(Ea형31례,Ⅰ형15례,Ⅱa형25례);담도탐사+담장문합술25례(Ea형14례,Eb형7례,Ec형4례);담도탐사+간담관공장분식문합술10례(Ⅱb형5례,Ⅱc형3례,Ea형2례);간단(협)절제+외혹내인류술70례(Ⅰ형30례,Ⅱb형20례,Ea형5례,Eb형12례,Ec형3례).결과 간절제조술후근기잔석솔、술후원기료효균우우비간절제술조[17.1％(12/70)대43.4％(46/106),91.4％(53/58)대77.0％(67/87)],단위수술기병발증발생솔고우비간절제술조[37.1％(26/70)대14.2％(15/106)].결론 간절제시Ⅰ형、Ⅱb형간내담관결석환자적수선술식,간문부담관공장분식문합술시Ⅱc형간내담관결석환자적주요술식.
Objective To investigate the therapeutic effects of varied operative for the treatment of intrahepatic bile duct stones.Methods The clinical data of 176 consecutive cases of hepatolithiasis surgically treated in the past 3 years in our hospital were retrospectively analyzed.There were 45 type Ⅰ patients,25 type Ⅱ a patients,25 type Ⅱ b patients,3 type Ⅱ c patients,52 type Ea patients,19 type Eb patients,and 7 type Ec patients.These 176 patients were divided into 4 groups according to modus operandi:choledocholithotomy and T-tube drainage in 71 patients (type Ea 31 patients,type Ⅰ 15 patients,type Ⅱ a 25 patients) ; choledocholithotomy and choledochojejunostomy in 25 patients (type Ea 14 patients,type Eb 7 patients,type Ec 4 patients) ; choledocholithotomy and hepaticojejunostomy in 10 patients (type Ⅱb 5 patients,type Ⅱ c 3 patients,type Ea 2 patients) ; hepatectomy plus T-tube drainage or choledochojejunostomy in 70 patients (type Ⅰ 30 patients,type Ⅱ b 20 patients,type Ea 5 patients,type Eb 12 patients,type Ec 3 patients).The postoperative residual stone rate,perioperative complications and long term results were compared between groups.Results Patients undergoing hepatectomy have less postoperative residual stone rate,higher rate of good long term efficacy as compared with those who did not undergo hepatectomy (17.1％ (12/70) vs 43.4％ (46/106),91.4％ (53/58) vs 77.0％ (67/87)).Though patients undergoing hepatectomy had higher rate of perioperative complications (37.1％ (26/70) vs 14.2％ (15/106)).Conclusions Hepatectomy is the most effective procedure for the treatment of type Ⅰ and type Ⅱ b hepatolithiasis.Hepaticojejunostomy is the main procedure for the treatment of type Ⅱ c hepatolithiasis.
