摘要
目的观察肝部分切除+胆总管切开取石、"T"管引流术辅以术中、术后胆道镜取石治疗肝内胆管结石的效果。方法回顾性分析1996年4月至2006年12月收治的92例肝内胆管结石患者,将其分为A、B两组。A组,47例,采用肝部分切除+胆总管切开取石、"T"管引流术,术中、术后辅以胆道镜取石治疗。B组,45例,采用胆总管切开取石、"T"管引流术,结合胆道镜取石治疗。结果A组术后2周的残石率为14.9%(7/47),2个月后采用纤维胆道镜经"T"管窦道取出残余结石1～2次,最终残石率为4.3%(2/47)。B组术后2周残石率为35.6%(16/45),2个月后采用纤维胆道镜经"T"管窦道取石4～5次,最终残石率为22.2%(10/45)。A组术后2周和2个月的残石率均明显低于B组(P值均<0.05)。两组间术后切口感染、胸腔积液、膈下感染及肺部感染等并发症发生率的差异均无统计学意义(P值均>0.05)。A组优良率为95.2%(40/42),显著优于B组的75.0%(30/40,P<0.01)。结论采用肝部分切除+胆总管切开取石、"T"管引流术,术中、术后辅以胆道镜取石治疗肝内胆管结石,优于单纯胆总管切开取石、"T"管引流的治疗方法。
Objective To investigate the therapeutic effects of partial hepatectomy assisted by choledochoscopy for hepatolithiasis. Methods A retrospective analysis was conducted among 92 patients with hepatolithias admitted from April, 1996 to Feb 2007. Of these patients, 47 underwent partial hepatectomy and choledochotomy with T-tube drainage and intra- and post-operative choledochoscopic calculus removal（group A）, and 45 underwent choledochotomy for calculus removal and T-tube drainage with also intra- and post-operative choledochoscopy （group B）. The therapeutic effects of the two surgical protocols were compared between the two groups after the operation. Results In group A, the rate of calculus remnant was 14.9% （7/47） 2 weeks after the primary surgery, which was lowered, 2 months later, to 4.3 % （2/47） after secondary choledochoscopy for calculus removal. The rate of calculus remnant in group B was 35.6% （16/45） after the primary surgery and lowered 2 months later to 22.2% （10/45） after 4 or 5 surgeries of choledochoscopic calculus removal, significantly higher than the rates in group A at both 2 weeks and 2 months. No significant differences were noted in the incidence of incison infection, pleural fluid, subphrenic infection or pulmonary infections between the two groups. Good therapeutic effect was achieved in 95.2% （40/42） of the patients in group A but only in 75% （30/40） of the patients in group B, showing significant difference between them （P 〈 0.01）. Conclusion Partial hepatectomy with T-tube drainage and intra- and post-operative choledochoscopy can be a more effective surgical protocol than choledochotomy with T-tube drainage in the management of hepatolithiasis. （Shanghai Med J, 2007, 30：902-904）
出处
《上海医学》
CAS
CSCD
北大核心
2007年第12期902-904,共3页
Shanghai Medical Journal
关键词
肝胆管结石
肝切除
内镜
Hepatolithiasis
Hepatectomy
Endoscopy
