2763例胆管结石手术引流方式的分析及对引流方式的再认识
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摘要
目的
探讨胆管结石手术引流方式随诊断技术和手术技巧的提高所发生的变迁。
方法
一、收集有资料记载的近22年(1986年1月——2007年12月)来自南昌大学第二附属医院胆管结石的病人资料。二、整理资料,得出病人的一般情况:病人的发病年龄、性别、结石的分布部位、病人采用了哪些诊断方法和治疗手段,以图表的形式将其列举出来。三、将这22年病例资料中手术引流的方式——T管引流和胆肠吻合引流的资料按1986年——1996年和1997年——2007年划分为二个时间段,汇总成四格表,用SPSS软件进行统计学分析。四、分析资料,探讨胆管结石手术引流方式变迁的原因。五、通过查阅文献资料了解上世纪60年代到现在我国胆管结石的治疗状况,了解我国胆管结石病人手术引流方式的变迁,并分析导致这些变化的可能原因。
结果
一、胆管结石的病人中女性的比例高于男性,且在上世纪80年代至今这个变化不是很大。二、结石的发病年龄高龄化,发病的年龄高峰有向后推移的趋势。三、上世纪60—80年代初、1986—1996年、1997—2007年这三个时间段胆管结石病人中T管引流和胆肠吻合引流在同期行手术治疗的病人中百分比分别是:74.70%和16.90%、54.13%和37.00%、67.68%和13.10%。四、通过统计学分析发现两组病例资料中T管引流和胆肠吻合百分率存在差异(p<0.001)。
结论
过去的近50年来,我国胆管结石病人手术引流方式经历了胆道探查+T管引流——胆肠吻合——病灶根治+T管引流三个阶段。
Objective
To evaluate the diversify on biliary drainage modus of calculus of bile duct following the improvement of diagnostic and surgical technique .
Methods
1.The clinical records of patients with calculus of bile duct who treated in the second affiliated hospital of Nanchang University in recent 22 years(1986-2007) were collected and to get the general information, such as the age of onset,the gender,the calculary distribution, the methods of diagnosis and therapy. 2. The charged tendency and reasons of biliary drainage modus which T-Tube drain and chole-intestinal anastomosis were analyzed. 3. To compare the data of our hospital with references about biliary drainage modus and analyze the possible reason of appearing these differences.
Results
1.The percentage of female patients of calculus of bile duct is higher than male patients through the statistical analysis of case data.The percentage of changing is ignore from 1980s to now.2.We discovered that the peak of age of onset is becoming older.3.In 1960-1980,1986-1996 and 1997-2007,the percentage of T-Tube Drain and chole-intestinal anastomosis in synchronized operation therapy is 74.70% with 16.90%、54.13% with 37.00%、67.68% with 13.10%,respectively.
Conclusions
In the past 50 years, the biliary drainage modus of calculus of bile duct in our country experienced 3 different periods,including biliary tract exploration + T-Tube Drain, chole-intestinal anastomosis and radical cure of the focus of infection + T-Tube Drain.
探讨胆管结石手术引流方式随诊断技术和手术技巧的提高所发生的变迁。
方法
一、收集有资料记载的近22年(1986年1月——2007年12月)来自南昌大学第二附属医院胆管结石的病人资料。二、整理资料,得出病人的一般情况:病人的发病年龄、性别、结石的分布部位、病人采用了哪些诊断方法和治疗手段,以图表的形式将其列举出来。三、将这22年病例资料中手术引流的方式——T管引流和胆肠吻合引流的资料按1986年——1996年和1997年——2007年划分为二个时间段,汇总成四格表,用SPSS软件进行统计学分析。四、分析资料,探讨胆管结石手术引流方式变迁的原因。五、通过查阅文献资料了解上世纪60年代到现在我国胆管结石的治疗状况,了解我国胆管结石病人手术引流方式的变迁,并分析导致这些变化的可能原因。
结果
一、胆管结石的病人中女性的比例高于男性,且在上世纪80年代至今这个变化不是很大。二、结石的发病年龄高龄化,发病的年龄高峰有向后推移的趋势。三、上世纪60—80年代初、1986—1996年、1997—2007年这三个时间段胆管结石病人中T管引流和胆肠吻合引流在同期行手术治疗的病人中百分比分别是:74.70%和16.90%、54.13%和37.00%、67.68%和13.10%。四、通过统计学分析发现两组病例资料中T管引流和胆肠吻合百分率存在差异(p<0.001)。
结论
过去的近50年来,我国胆管结石病人手术引流方式经历了胆道探查+T管引流——胆肠吻合——病灶根治+T管引流三个阶段。
Objective
To evaluate the diversify on biliary drainage modus of calculus of bile duct following the improvement of diagnostic and surgical technique .
Methods
1.The clinical records of patients with calculus of bile duct who treated in the second affiliated hospital of Nanchang University in recent 22 years(1986-2007) were collected and to get the general information, such as the age of onset,the gender,the calculary distribution, the methods of diagnosis and therapy. 2. The charged tendency and reasons of biliary drainage modus which T-Tube drain and chole-intestinal anastomosis were analyzed. 3. To compare the data of our hospital with references about biliary drainage modus and analyze the possible reason of appearing these differences.
Results
1.The percentage of female patients of calculus of bile duct is higher than male patients through the statistical analysis of case data.The percentage of changing is ignore from 1980s to now.2.We discovered that the peak of age of onset is becoming older.3.In 1960-1980,1986-1996 and 1997-2007,the percentage of T-Tube Drain and chole-intestinal anastomosis in synchronized operation therapy is 74.70% with 16.90%、54.13% with 37.00%、67.68% with 13.10%,respectively.
Conclusions
In the past 50 years, the biliary drainage modus of calculus of bile duct in our country experienced 3 different periods,including biliary tract exploration + T-Tube Drain, chole-intestinal anastomosis and radical cure of the focus of infection + T-Tube Drain.
引文
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[22] 刘颖斌,彭淑牖. 胆肠吻合术后再次或多次手术的原因和处理[J].中国实用外科杂志,2006,26(3):165-167.
[23] 黄志强.胆道疾病中的热点问题[J].医学研究杂志,2007,36(4):1-3.
[24] 刘庆全. 肝内胆管结石的手术治疗近况[J]. 肝胆胰外科杂志,2002,14(4):254-255.
[25] 梁力建. 努力避免非计划性的胆道再次手术[J].中国实用外科杂志,2006,26(3):161-162.
[26] 朱红,李立春,李晓,等. B 超、ERCP 对胆管结石的诊断价值[J]. 昆明医学院学报,1999,20(1):48-50.
[27] 盂翔凌,徐阿曼,高山城,等. 肝内胆管结石 1 795 例的外科治疗[J].中华肝胆外科杂志,2001,7(10):587-589.
[28] 朱耀明,郑军,王秉成. 肝内胆管结石 2 00 例外科治疗[J].中华肝胆外科杂志,2003,9(12):760-761.
[29] 董家鸿. 肝胆管结石临床病理类型与手术方式的选择. 第二届中国外科周. 厦门,2003.
[30] 黄志强. 肝内胆管结石外科治疗的进展[J].中国实用外科杂志,2004,24(2):65-66.
[31] 黄志强. 右后段肝胆臂阻塞的手术处理[J].中华外科杂志,1988,26(5):593-595.
[32] 黄志强,黄文,韩本立,等.肝胆管结石症的外科治疗[J].中华外科杂志.1964.增刊 67.
[33] 黄志强.右肝内胆管钻石的肝段切除术[J].肝胆外科杂志.1994.9(2):65-67.
[34] 黄志强. 当今胆道外科的发展与方向[J]. 中国现代普通外科进展 2007,4(2):93-95.
[35] 谭毓铨,王贵民. 肝胆管结石的外科治疗展望[J].临床外科杂志,2005,13(7):399-400.
[36] 黄志强. 肝内胆管结石治疗的现状与展望[J]. 中国普外基础与临床杂志,2001,3(2):65-67.
[37] Jan YY , chen MF , Wang CS. Surgical treatment of hepatolithiasis: long —term results[J].Surgery,1996,120(3):509—514.
[38] Jeng KS,Ohta I,Yang FS.Reappraisal of the systemic management of complicated hepatolithiasis with bilateral intrahepatic biliary strictures[J].Arch Surg,1996,131(2):141—147.
[1] 顾倬云,黄志强,中国人胆石的特点[J].中华外科杂志,1987,25:32.
[2] 魏北有,陈起衡,叶绍裘,等.623 例肝胆管结石临床分析[J].中华外科杂志,1983,21(6):335-337.
[3] 赵登秋,陈一尘,朱克明,等. 36 例胆道探查 T 管引流术后并发症的原因及防治[J]. 肝胆外科杂志 2005,13(4):294-296.
[4] 蔡景修,黄志强,韩立本,等. 749 例肝内胆管结石外科治疗的临床分析[J]. 第三军医大学学报,1996,18(1):59-61.
[5] 王炳煌,李立春,张小文,等. 肝内胆管结石的外科治疗(34 年 1 448 例总结) [J].中华肝胆外科杂志,2001,7(10):583-586.
[6] 窦科峰, 李海民. 肝胆管结石的综合治疗与个体化处理[J].中国实用外科杂志,2004,24(2):70-72.
[7] 刘颖斌,彭淑牖. 胆肠吻合术后再次或多次手术的原因和处理[J].中国实用外科杂志,2006,26(3):165-167.
[8] 黄志强.胆道疾病中的热点问题[J].医学研究杂志,2007,36(4):1-3.
[9] 刘庆全. 肝内胆管结石的手术治疗近况[J]. 肝胆胰外科杂志,2002,14(4):254-255.
[10] 梁力建. 努力避免非计划性的胆道再次手术[J].中国实用外科杂志,2006,26(3):161-162.
[11] 朱红,李立春,李晓,等. B 超、ERCP 对胆管结石的诊断价值[J]. 昆明医学院学报,1999,20(1):48-50.
[12] 盂翔凌,徐阿曼,高山城,等. 肝内胆管结石 1 795 例的外科治疗[J].中华肝胆外科杂志,2001,7(10):587-589.
[13] 朱耀明,郑军,王秉成. 肝内胆管结石 2 00 例外科治疗[J].中华肝胆外科杂志,2003,9(12):760-761.
[14] 董家鸿. 肝胆管结石临床病理类型与手术方式的选择. 第二届中国外科周. 厦门,2003.
[15] 黄志强. 肝内胆管结石外科治疗的进展[J].中国实用外科杂志,2004,24(2):65-66.
[16] 黄志强 右后段肝胆臂阻塞的手术处理[J].中华外科杂志,1988,26:593.
[17] 黄志强,黄文,韩车立,等.肝胆管结石症的外科治疗[J].中华外科杂志.1964.增刊 67.
[18] 黄志强.右肝内胆管钻石的肝段切除术[J].肝胆外科杂志.1994.2:65.
[19] 黄志强. 当今胆道外科的发展与方向[J]. 中国现代普通外科进展 2007,4(2):93-95.
[20] 谭毓铨,王贵民. 肝胆管结石的外科治疗展望.临床外科杂志,2005,13(7):399-400.
[21] 黄志强. 肝内胆管结石治疗的现状与展望[J]. 中国普外基础与临床杂志,2001,3(2):65-67.
[22] Jan YY , chen MF , Wang CS. Surgical treatment of hepatolithiasis: long —term results[J].Surgery,1996,120:5O9—510.
[23] Jeng KS,Ohta I,Yang FS.Reappraisal of the systemic management of complicated hepatolithiasis with bilateral intrahepatic biliary strictures[J].Arch Surg,1996,131,131—141.
[24] 黄志强,顾倬云,张晓卫,等.我国肝内胆管结石外科治疗的现况—全国4197例手术病例的分析[J].中华外科杂志,1988,26:513-522.
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