肝内胆管结石外科治疗的临床研究单一手术组76例临床总结
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摘要
目的探讨肝内胆管结石外科个体化治疗方案的有效实施及其疗效。方法安徽医科大学第一附院普外科器官移植中心病区2006年3月至2011年7月共收治76例肝内胆管结石患者按是否施行了联合肝叶切除分成:胆管切开取石联合肝叶切除组(A组)、单纯胆管切开取石组(B组),所有患者临床资料进行回顾性分析。结果 A、B两组间住院时间、手术时间及相关手术并发症的发生情况无明显差异(P> 0. 05),76位患者中,65例获得随访,随访率85. 5%(65/76),随访患者中A、B两组间术后胆管炎发生情况无明显差异(P> 0. 05)。结论个体化选择肝叶切除和内、外引流术,可以降低术后残石率并改善外科治疗效果。
Objective To explore reasonable selections of surgical approaches and their efficacy. Method We retrospectively collected perioperative data of all the patients with intrahepatic bile duct stones from the department of general surgery of the First Affiliated Hospital of Anhui Medical University between March 2006 and July 2011. The patients with intrahepatic bile duct stones were divided into hepatectomy group( A group) and non-hepatectomy group( B group). All of them were enrolled into this retrospective study. Results No significant differences were observed between two groups in aspects of hospitalized duration,operation time and the above-mentioned complications( P > 0. 05). In all 76 patients,65 cases were followed up,with an 85. 5% of follow-up rate. No significant differences were observed between two groups in cholangitis recurrence( P > 0. 05). Conclusion Individual operative approaches should be selected according to the distribution of gallstones,biliary conditions and various other clinical features,with the hope for reducing postoperative complications.
Objective To explore reasonable selections of surgical approaches and their efficacy. Method We retrospectively collected perioperative data of all the patients with intrahepatic bile duct stones from the department of general surgery of the First Affiliated Hospital of Anhui Medical University between March 2006 and July 2011. The patients with intrahepatic bile duct stones were divided into hepatectomy group( A group) and non-hepatectomy group( B group). All of them were enrolled into this retrospective study. Results No significant differences were observed between two groups in aspects of hospitalized duration,operation time and the above-mentioned complications( P > 0. 05). In all 76 patients,65 cases were followed up,with an 85. 5% of follow-up rate. No significant differences were observed between two groups in cholangitis recurrence( P > 0. 05). Conclusion Individual operative approaches should be selected according to the distribution of gallstones,biliary conditions and various other clinical features,with the hope for reducing postoperative complications.
引文
1中华医学会外科学分会胆道外科学组.肝胆管结石病诊断治疗指南.中华消化外科杂志,2007,6:156-161.
2 Plentz RR,Malek NP.Clinical presentation,risk factors and staging systems of cholangiocarcinoma.Best Pract Res Clin Gastroenterol,2015,29(2):245-252.
3黄志强.新世纪的胆道外科.临床外科杂志,2004,12(1):12-14.
4黄志强.手术后胆管残石的过去、现状和对策.中国实用外科杂志,2000,20(9):515-516.
5 Kazuhia U,Hironobu O,Masaji T,et al.Indication and procedure for treatment of hepatolithiasis.Arch Surg,2002,137:149-153.
6冯明明,周青.规则性肝部分切除术治疗老年肝内胆管结石的疗效.中国老年学杂志,2015,35(1):45-47.
7黄志强主编.当代胆道外科学.上海:上海科学技术文献出版社,1988:409-410.
8 Jarufe N.Figueroa E,Munoz C,et al.Anatomic hepatectomy as a definitive treatment for hepatolithiasis:a cohort study.HPB(Ox-ford),2012,14(9):604-610.
9 Shoda J,Tanaka N,Osuga T.Hepatolithiasis-epidemiology and pathogenesis update.Front Biosci,2003,8:398-409.
10吴一武,梁建深,杨志伟,等.电子胆道镜在胆道疾病中的应用体会.普通外科学文献,2005,2:168-169.
11汤恢焕,周军,肖广发,等.外科治疗2465例原发性肝内胆管结石的临床总结.中华外科杂志,2006,44,1610-1613.
12 Cheung MT,Kwok PC.Liver resection for intrahepatic stones.Arch Surg,2005,140:993-997.
2 Plentz RR,Malek NP.Clinical presentation,risk factors and staging systems of cholangiocarcinoma.Best Pract Res Clin Gastroenterol,2015,29(2):245-252.
3黄志强.新世纪的胆道外科.临床外科杂志,2004,12(1):12-14.
4黄志强.手术后胆管残石的过去、现状和对策.中国实用外科杂志,2000,20(9):515-516.
5 Kazuhia U,Hironobu O,Masaji T,et al.Indication and procedure for treatment of hepatolithiasis.Arch Surg,2002,137:149-153.
6冯明明,周青.规则性肝部分切除术治疗老年肝内胆管结石的疗效.中国老年学杂志,2015,35(1):45-47.
7黄志强主编.当代胆道外科学.上海:上海科学技术文献出版社,1988:409-410.
8 Jarufe N.Figueroa E,Munoz C,et al.Anatomic hepatectomy as a definitive treatment for hepatolithiasis:a cohort study.HPB(Ox-ford),2012,14(9):604-610.
9 Shoda J,Tanaka N,Osuga T.Hepatolithiasis-epidemiology and pathogenesis update.Front Biosci,2003,8:398-409.
10吴一武,梁建深,杨志伟,等.电子胆道镜在胆道疾病中的应用体会.普通外科学文献,2005,2:168-169.
11汤恢焕,周军,肖广发,等.外科治疗2465例原发性肝内胆管结石的临床总结.中华外科杂志,2006,44,1610-1613.
12 Cheung MT,Kwok PC.Liver resection for intrahepatic stones.Arch Surg,2005,140:993-997.