CAJ | 학술논문

目的探讨左肝外叶胆管结石的肝叶切除范围.方法回顾性分析110例肝叶切除治疗左肝外叶胆管结石的临床资料,其中42例行单纯左肝外叶切除作为标准组,68例行左肝外叶加部分内叶切除或左半肝切除作为扩大组.结果 2组均顺利完成手术,无围手术期死亡病例,标准组和扩大组在手术时间[(82±23) min比(98±37) min]、术中出血量[(450±270) ml比(610±280)ml]、肝断面胆漏发生率(16.7％比16.2％)、肝断面积液发生率(4.8％比8.8％)、肝断面出血量[(120±75)ml比(230±110) ml]、肝断面引流管留置时间[(6.3±2.6)d比(6.8±3.1)d]、术后3dALT差值[(182±98) U/L比(212±107) U/L]、术后3d胆红素差值[(21±7) mol/L比(18±6) mol/L]、术后3dPT差值[(1.0±0.6)s比(0.9±0.5)s]和术后住院时间[(7.8±1.9)d比(8.6±2.1)d]比较差异均无统计学意义(均P＞ 0.05).标准组左肝内叶胆管结石残留和复发率分别为14.3％和11.9％,扩大组无结石残留和复发,2组差异有统计学意义(P＜0.05).结论局限于左肝外叶的肝内胆管结石,左肝外叶切除加部分内叶切除或左半肝切除是安全有效的.
목적 탐토좌간외협담관결석적간협절제범위.방법 회고성분석110례간협절제치료좌간외협담관결석적림상자료,기중42례행단순좌간외협절제작위표준조,68례행좌간외협가부분내협절제혹좌반간절제작위확대조.결과 2조균순리완성수술,무위수술기사망병례,표준조화확대조재수술시간[(82±23) min비(98±37) min]、술중출혈량[(450±270) ml비(610±280)ml]、간단면담루발생솔(16.7％비16.2％)、간단면적액발생솔(4.8％비8.8％)、간단면출혈량[(120±75)ml비(230±110) ml]、간단면인류관류치시간[(6.3±2.6)d비(6.8±3.1)d]、술후3dALT차치[(182±98) U/L비(212±107) U/L]、술후3d담홍소차치[(21±7) mol/L비(18±6) mol/L]、술후3dPT차치[(1.0±0.6)s비(0.9±0.5)s]화술후주원시간[(7.8±1.9)d비(8.6±2.1)d]비교차이균무통계학의의(균P＞ 0.05).표준조좌간내협담관결석잔류화복발솔분별위14.3％화11.9％,확대조무결석잔류화복발,2조차이유통계학의의(P＜0.05).결론 국한우좌간외협적간내담관결석,좌간외협절제가부분내협절제혹좌반간절제시안전유효적.
Objective To evaluate extended vs standard left lateral lobectomy for left lateral lobe hepatolithiasis.Methods A retrospective study was conducted on the clinical data of 110 patients who underwent hepatectomy for hepatolithiasis limited to left lateral lobe of the liver.Results 42 patients received left lateral lobectomy, 68 patients did left hemihepatectomy.There were no marked difference between the two groups in the operation time, introperation or postoperation blood loss, bile leak and bleeding on the hepatic cut surface, liver function and the postoperative hospital stay.The incidence of residual and recurrent stones was 14.3％ and 11.9％ in left lateral lobectimy group and 0％, 0％ in left hemihepatectomy group.Conclusion Left hemihepatectomy for left lateral lobe hepatolithiasis is a safe and effective procedure.