贵阳医学院学报
貴暘醫學院學報
귀양의학원학보
JOURNAL OF GUIYANG MEDICAL COLLEGE
2015年
6期
619-622
,共4页
罗耀兵%江建新%潘耀振%孙诚谊
囉耀兵%江建新%潘耀振%孫誠誼
라요병%강건신%반요진%손성의
肝切除术%胆道镜%手术方式%胆结石
肝切除術%膽道鏡%手術方式%膽結石
간절제술%담도경%수술방식%담결석
partial hepatectomy%choledochoscope%operation mode%cholelithiasis
目的：比较肝部分切除联合胆道镜探查取石、胆总管切开取石“T”管引流以及胆管空肠Roux-en-Y吻合3种手术方式在治疗肝内外胆管结石中的临床疗效。方法：分析241例肝内外胆管结石患者的临床资料，比较肝部分切除联合胆道镜探查取石（ A组）、胆总管切开取石“T”管引流（ B组）以及胆管空肠Roux-en-Y吻合（C组）3种术式术后患者的结石残留率、结石复发率、胆管炎发生率以及再次手术率。结果：A组结石残留率（9.5％）低于B组（29.4％）和C组（38.2％），A组结石复发率（8.4％）低于B组（20.2％）和C组（22.2％），A组胆管炎发生率（7.2％）低于B组（19.1％）和C组（37％），A组再次手术率（2.4％）低于B组（13.1％）和C组（11.1％），差异均有统计学意义（ P＜0.05）。结论：肝部分切除术是治疗肝内外胆管结石有效的手术方式，联合应用胆道镜探查取石，可明显提高远期疗效。
目的：比較肝部分切除聯閤膽道鏡探查取石、膽總管切開取石“T”管引流以及膽管空腸Roux-en-Y吻閤3種手術方式在治療肝內外膽管結石中的臨床療效。方法：分析241例肝內外膽管結石患者的臨床資料，比較肝部分切除聯閤膽道鏡探查取石（ A組）、膽總管切開取石“T”管引流（ B組）以及膽管空腸Roux-en-Y吻閤（C組）3種術式術後患者的結石殘留率、結石複髮率、膽管炎髮生率以及再次手術率。結果：A組結石殘留率（9.5％）低于B組（29.4％）和C組（38.2％），A組結石複髮率（8.4％）低于B組（20.2％）和C組（22.2％），A組膽管炎髮生率（7.2％）低于B組（19.1％）和C組（37％），A組再次手術率（2.4％）低于B組（13.1％）和C組（11.1％），差異均有統計學意義（ P＜0.05）。結論：肝部分切除術是治療肝內外膽管結石有效的手術方式，聯閤應用膽道鏡探查取石，可明顯提高遠期療效。
목적：비교간부분절제연합담도경탐사취석、담총관절개취석“T”관인류이급담관공장Roux-en-Y문합3충수술방식재치료간내외담관결석중적림상료효。방법：분석241례간내외담관결석환자적림상자료，비교간부분절제연합담도경탐사취석（ A조）、담총관절개취석“T”관인류（ B조）이급담관공장Roux-en-Y문합（C조）3충술식술후환자적결석잔류솔、결석복발솔、담관염발생솔이급재차수술솔。결과：A조결석잔류솔（9.5％）저우B조（29.4％）화C조（38.2％），A조결석복발솔（8.4％）저우B조（20.2％）화C조（22.2％），A조담관염발생솔（7.2％）저우B조（19.1％）화C조（37％），A조재차수술솔（2.4％）저우B조（13.1％）화C조（11.1％），차이균유통계학의의（ P＜0.05）。결론：간부분절제술시치료간내외담관결석유효적수술방식，연합응용담도경탐사취석，가명현제고원기료효。
Objective:To discuss and compare clinical efficacy of partial hepatectomy combined with choledochoscope for exploration and stone removal,choledochotomy for stone removal and T tube drainage and Roux-en-Y choledochojejunostomy in treating intra-and extrahepatic biliary duct stones. Methods:A total of 241 cases of patients with intra-and extrahepatic bile duct stones were enrolled in this study and divided into 3 goups:A group( partial hepatectomy combined with choledochoscope for exploration and stone removal),B group( choledochotomy for stone removal and T tube drainage),C group( Roux-en-Y choledochojejunostomy). The clinical data of 3 groups were analyzed retrospectively to compare rate of residual stone,rate stone recurrence,incidence of cholangitis and rate of reopera-tion. Results:The rate of residual stone in A group( 9. 5%) was lower than that in B group (29. 4%)and C group(38. 2%). The rate of stone recurrence in A group(8. 4%)was lower than that in B groups(20. 2%)and C group(22. 2%). The incidence of cholangitis in A group(7. 2%) was lower than that in B group( 19 . 1%)and C group( 37%). The rate of reoperation in A group (2. 4%)was lower than that in B group(13. 1%)and C group(11. 1%). All the differences were statistically significant( P <0 . 05 ). Conclusion:Partial hepatectomy is the most effective surgical procedure to treat the intra-and extrahepatic bile duct stones,whose clinical efficacy can be improved when combined with choledochoscope.
