中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2015年
7期
442-444
,共3页
陈阳%余小舫%鲍世韵%孙枫林%张卓%马扬
陳暘%餘小舫%鮑世韻%孫楓林%張卓%馬颺
진양%여소방%포세운%손풍림%장탁%마양
肝胆管结石病%胆道镜%规则性肝切除术%磁共振成像%磁共振胰胆管造影
肝膽管結石病%膽道鏡%規則性肝切除術%磁共振成像%磁共振胰膽管造影
간담관결석병%담도경%규칙성간절제술%자공진성상%자공진이담관조영
Hepatolithiasis%Choledochoscopy%Regular hepatectomy%MRI%MRCP
目的 比较规则性肝叶切除术与胆总管切开取石术两者联合术中及术后胆道镜治疗肝胆管结石病的远期疗效.方法 回访完成上述两类术式的肝胆管结石病例并复查肝胆磁共振(增强MRI+ MRCP),对比两组异常影像学表现发生率.结果 成功回访268例患者,其中规则性肝叶切除为主的联合手术138例,胆总管切开取石为主的联合手术130例.对比分析显示肝切除组多个指标显著优于取石组,两组差异具有统计学意义.急性胆管炎并结石复发率(5.8%比21.5%),再手术率(5.8%比21.5%),胆管狭窄率(8.0%比44.6%),肝实质异常灌注率(4.3%比23.1%),肝内胆管增强/增厚发生率(1.5%比26.9%),肝段萎缩发生率(3.0%比30.0%),胆管癌发生率(0比2.3%).结论 因没有去除病灶,胆总管切开取石联合胆道镜术后远期不良事件发生率较肝切除组高,前者应视为切肝术的重要补充.
目的 比較規則性肝葉切除術與膽總管切開取石術兩者聯閤術中及術後膽道鏡治療肝膽管結石病的遠期療效.方法 迴訪完成上述兩類術式的肝膽管結石病例併複查肝膽磁共振(增彊MRI+ MRCP),對比兩組異常影像學錶現髮生率.結果 成功迴訪268例患者,其中規則性肝葉切除為主的聯閤手術138例,膽總管切開取石為主的聯閤手術130例.對比分析顯示肝切除組多箇指標顯著優于取石組,兩組差異具有統計學意義.急性膽管炎併結石複髮率(5.8%比21.5%),再手術率(5.8%比21.5%),膽管狹窄率(8.0%比44.6%),肝實質異常灌註率(4.3%比23.1%),肝內膽管增彊/增厚髮生率(1.5%比26.9%),肝段萎縮髮生率(3.0%比30.0%),膽管癌髮生率(0比2.3%).結論 因沒有去除病竈,膽總管切開取石聯閤膽道鏡術後遠期不良事件髮生率較肝切除組高,前者應視為切肝術的重要補充.
목적 비교규칙성간협절제술여담총관절개취석술량자연합술중급술후담도경치료간담관결석병적원기료효.방법 회방완성상술량류술식적간담관결석병례병복사간담자공진(증강MRI+ MRCP),대비량조이상영상학표현발생솔.결과 성공회방268례환자,기중규칙성간협절제위주적연합수술138례,담총관절개취석위주적연합수술130례.대비분석현시간절제조다개지표현저우우취석조,량조차이구유통계학의의.급성담관염병결석복발솔(5.8%비21.5%),재수술솔(5.8%비21.5%),담관협착솔(8.0%비44.6%),간실질이상관주솔(4.3%비23.1%),간내담관증강/증후발생솔(1.5%비26.9%),간단위축발생솔(3.0%비30.0%),담관암발생솔(0비2.3%).결론 인몰유거제병조,담총관절개취석연합담도경술후원기불량사건발생솔교간절제조고,전자응시위절간술적중요보충.
Objective To compare the long-term outcomes of partial hepatectomy versus choledocholithotomy both combined with choledochoscopy,for the treatment of hepatolithiasis.Methods Patients who underwent either type of the operations were followed up and examined using hepatobiliary magnetic resonance (enhanced MRI + MRCP).The incidences of abnormal imaging in the two groups were compared.Results Of 268 patients,138 patients underwent partial hepatectomy and the remaining 130 patients underwent choledocholithotomy.When hepatectomy was compared with choledocholithotomy,the recurrence rate of acute cholangitis combined with bile duct stone (5.8% vs.21.5%),the reoperation rate (5.8% vs.21.5%),the bile duct stricture rate (8.0% vs.44.6%),the abnormal liver parenchyma perfusion rate (4.3% vs.23.1%),the incidence of intrahepatic bile duct enhancement or thickening (1.5% vs.26.9%),the incidence of hepatic atrophy (3.0% vs.30.0%) and the incidence of cholangiocarcinoma (0 vs.2.3%) were better.Conclusions The long-term adverse outcomes were significantly worse in the choledocholithotomy group than in the partial hepatectomy group.Choledocholithotomy combined with choledochoscopy should only be considered as a complementary procedure to partial hepatectomy in hepatolithiasis.