摘要
本研究通过对吉林大学第一临床医院普外科2006年1月至2009年8月间收治的145例肝胆管结石病患者进行回顾性分析,其中胆管切开取石T管引流73例,规则性肝叶(或段)切除60例(其中3例同时行胆管空肠Roux-en-Y吻合术),胆管空肠Roux-en-y吻合术12例,服用中药59例,未服用中药76例。通过比较不同术式的残余结石率、结石复发率,以及服用中药组与未服用中药组的胆道镜取石次数、结石复发率,来对比不同治疗方法的疗效。结果发现肝叶(段)切除组残余结石率低于胆道切开取石组(P<0.05),两组结石复发率无显著差异(P>0.05);胆道切开取石术中腹腔镜组与开腹手术之间术后残余结石率无显著差异(P>0.05);残余结石患者中胆道镜取石次数,口服中药者与未服用中药者有统计学差异(P <0.05)。无残留结石患者中,不论胆道切开取石术还是肝叶(段)切除术,口服中药组结石复发率较未服中药组低(P<0.05)。通过研究我们发现,在肝内胆管结石的治疗中,应选择手术治疗结合术中、术后胆道镜以及中药排石的综合治疗方法。
Objective: To analyze the results of comprehensive treatment of intrahepa- tolithiasis.
Methods: one hundred and forty-five cases of intrahepatolithiasis treated in the First Hospital of Jilin University from January 2006 to August 2009 were summarized and analyzed retrospectively, and all the cases were treated by the following surgical procedures: choledochostomy, regular hepatolobectomy, Roux-en-Y cholangiohepaticojejunostomy, hepatolobectomy plus cholangiohe- paticojejunostomy, etal, with the application of choledochoscopy during or after operations, and taking traditional Chinese medicine after operations. The statistical method is used in the data analysis.
Results: 73 cases underwent choledochostomy and T-Tube drainage, 60 cases underwent regular hepatolobectomy (3 cases plus cholangiohepa- ticojejunostomy), 12 cases underwent Roux-en-Y cholangiohepaticojejunostomy. 23 cases had postoperative bile duct retained stones(15.86%), 22 cases had postoperative complications(15.17%), of them 1 fatal cases(0.69%). The ratio of bile duct retained stones of the partial hepatectomy was lower than that of the choledochostomy(P<0.05), but the ratio of stones recurrence was not different between them(P>0.05); In the patients of choledochostomy, there were no differences between the laparoscopic and the open in the ratio of bile duct retained stones(P > 0.05); according to the numbers of choledochoscope application during the patients with retained stones, there were differences between the traditional Chinese medicine taking and the non-taking; during the patients with no retained stones, whether the choledochostomy or the partial hepatectomy, the ratio of stones recurrence of the traditional Chinese medicine taking is lower than the non-taking. During the follow-up, Excellent rate of all patients was 95%.
Conclusion: during the treatment of intrahepatolithiasis, we could choose the comprehensive treatment with operations, intraoperative and postoperative choledochoscope application, and taking the traditional Chinese medicine.
引文
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