解剖性肝切除术治疗复杂肝内胆管结石体会
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摘要
目的探讨解剖性肝切除术治疗复杂肝内胆管结石的价值。方法回顾性分析2012年1月至2017年3月行肝切除术的98例复杂肝内胆管结石病人的临床资料,男性42例,女性56例,年龄28~69岁,平均47.2岁。其中行解剖性肝切除术51例(AR组),非解剖性肝切除术47例(NAR组)。对比两种手术方式病人的术中出血量、手术时间、肝功能恢复情况、住院时间、术后并发症、术后残石率和结石复发率。比较两种手术方式的治疗效果。结果 AR组病人术中出血量为(466.0±52.1)ml、术后并发症8例(17.65%)、术后残石率为0和结石复发1例(2.04%),明显优于NAR组的(741.0±46.3)ml、15例(29.79%)、3例(6.67%)和4例(8.89%)。而手术时间、肝功能恢复情况、住院时间差异均无统计学意义。术后2个月至5年获随访94例,其中AR组49例,NAR组45例,失访4例。均行B超、CT、MRCP等检查,AR组无结石残留,术后胆总管结石复发1例,行内镜下十二脂肠乳头括约肌切开术(EST)取石治愈。NAR组结石残留3例,结石复发4例。在术后8个月至3年内再次行解剖性肝叶肝段切除3例,1例行EST取石成功,1例长期服用熊去氧胆酸等药物治疗未手术,另2例因经济原因放弃治疗。结论解剖性肝切除术治疗复杂肝内胆管结石,具有术中出血少、术后并发症少、术后残石率和复发率低的优势,是一种可选择的手术方式。
Objective To discuss the value of anatomic hepatectomy in the treatment of complicated intrahepatic bile duct stones. Methods The clinical data of 98 patients with complicated intrahepatic bile duct stones undergoing hepatectomy were retrospectively analyzed in our hospital from January 2012 to March2017. Among them,51 cases were given anatomical liver resection,and 47 cases received non-anatomical liver resection. The blood loss,operation time,recovery of liver function,hospital stay,postoperative complications,postoperative residual stone rate and recurrence rate of the two kinds of operations were compared. The curative efficacy of two operations was also compared. Results There was significant difference intraoperative bleeding,postoperative complications,postoperative residual stone rate and the recurrence rate between Anatomical liver resection group and non-anatomical liver resection. However,there was no significant difference in operation time,liver function recovery and hospitalization time between two groups. Conclusions Anatomical hepatectomy for complex intrahepatic bile duct stones has advantages of less bleeding,less postoperative complications,less residual stone rate and lower recurrence rate. It is an alternative surgical procedure.
Objective To discuss the value of anatomic hepatectomy in the treatment of complicated intrahepatic bile duct stones. Methods The clinical data of 98 patients with complicated intrahepatic bile duct stones undergoing hepatectomy were retrospectively analyzed in our hospital from January 2012 to March2017. Among them,51 cases were given anatomical liver resection,and 47 cases received non-anatomical liver resection. The blood loss,operation time,recovery of liver function,hospital stay,postoperative complications,postoperative residual stone rate and recurrence rate of the two kinds of operations were compared. The curative efficacy of two operations was also compared. Results There was significant difference intraoperative bleeding,postoperative complications,postoperative residual stone rate and the recurrence rate between Anatomical liver resection group and non-anatomical liver resection. However,there was no significant difference in operation time,liver function recovery and hospitalization time between two groups. Conclusions Anatomical hepatectomy for complex intrahepatic bile duct stones has advantages of less bleeding,less postoperative complications,less residual stone rate and lower recurrence rate. It is an alternative surgical procedure.
引文
1吴晓,夏灏,吴健,等.规则肝切除术治疗复杂肝内胆管结石的临床体会.临床肝胆病杂志,2016,32:1756-1759.
2朱继业,高鹏骥.肝内胆管结石的外科治疗.中华普外科手术学杂志(电子版),2012,11:345-350.
3 Tomimaru Y,Eguchi H,Marubashi S,et al.Equivalent outcomes afteranatomical and non-anatomical resection of small hepatocellularcarcinoma in patients with preserved liver function.Dig Dis Sci,2012,57:1942-1948.
4王甸北,赵礼金,涂奎,等.解剖性肝切除术治疗肝内胆管结石的效果观察.临床肝胆病杂志,2017,33:102-105.
5朱卫东,谭兴国,邓如岗,等.精准肝切除技术在治疗右侧肝胆管结石中的应用.中国现代普通外科进展,2013,16:451-454.
6黄志强.肝内胆管结石治疗演变和发展.中国实用外科杂志,2015,35:468-470.
7 Jia CK,Weng J,Chen YK,et al.Hepatectomy with primary closure of common bile duct for hepatolithiasis combined with choledocholithiasis.World J Gastroenterol,2015,21:3564-3570.DOI:10.3748/wjg.v21.i12.3564.
8 Ran X,Yin B,Ma B.Four major factors contributing to intrahepatic stones.Gastroenterol Res Pract,2017,2017:7213043.DOI:10.1155/2017/7213043.
9 Shah OJ,Robbani I,Shah P,et al.Left-sided hepatic resection for hepatolithiasis:a longitudinal study of 110 patients.HPB(Oxford),2012,14:764-771.DOI:10.1111/j.1477-2574.2012.00534.
10中华医学会外科学分会胆道外科学组.肝内胆管结石病诊断治疗指南.中华消化外科杂志,2007,6:156-161.
11王坚.复杂肝内胆管结石的诊断与处理.中国实用外科杂志,2016,36:292-295.
12陈晓鹏,崔巍.精准外科时代胆管结石的诊断与治疗.肝胆胰外科杂志,2012,24:353-355.DOI:10.3969/j.issn.1007-1954.2012.05.001.
13刘付宝,王国斌,罗毅钊,等.精准肝脏外科理念在肝胆管结石病治疗中的临床价值.中华消化外科杂志,2014,13:447-451.DOI:10.3760/cma.j.issn.1673-9752.2014.06.009.
14 Lopes-Junior AG,Belebecha V,Jacob CE.Hepatectomy:a critical analysis on expansion of the indications.Arq Bras Cir Dig,2014,27:47-52.
15付宁,罗道蕴.规则肝切除在复杂肝内胆管结石治疗中的应用研究.成都医学院学报,2014,9:722-724.DOI:10.3969/j.issn.1674-2257.2014.06.019.
16刘思宇.多肝段切除治疗复杂肝内胆管结石临床分析.白求恩军医学院学报,2013,11:301-303.DOI:10.3969/j.issn.1672-2876.2013.04.008.
17钱言,孙礼侠.肝内胆管结石的外科治疗进展.医学研究杂志,2015,44:171-174.DOI:10.3969/j.issn.1673-548X.2015.03.050.
18唐诗彬,陈小伍,吴路杨,等.Glisson鞘解剖性肝切除术治疗肝内胆管结石.中华肝脏外科手术学电子杂志,2016,5:148-152.DOI:10.3877/cma.j.issn.2095-3232.2016.03.006.
19 Hyodo T,Kumano S,Kushihata F,et al.CT and MR cholangiography:advantages and pitfalls in perioperative evaluation of biliary tree.Br JRadiol,2012,85:887-896.DOI:10.1259/bjr/21209407.
20叶启文,林枫,张春,等.复杂肝内胆管结石326例个体化治疗.肝胆胰外科杂志,2014,26:356-358.
21金山.肝内胆管结石的病因及发病机制.世界华人消化杂志,2012,20:3324-3328.
22陈平,皮儒先.肝内胆管结石的外科治疗研究进展.中国普外基础与临床杂志,2014,21:1192-1193.DOI:10.7507/1007-9424.20140286.
23吴杨,黄强,胡元国,等.手术治疗复杂性肝内胆管结石的临床分析.肝胆外科杂志,2012,20:355-356.DOI:10.3969/j.issn.1006-4761.2012.05.012.
24周毅,胡亿龙,袁晟光,等.原发性肝内胆管结石的病因及外科治疗新进展.肝胆胰外科杂志,2016,28:351-352.DOI:10.11952/j.issn.1007-1954.2016.04.027.
25 Jarufe N,Figueroa E,Mu1oz C,et al.Anatomic hepatectomy as a definitive treatment for hepatolithiasis:a cohort study.HPB(Oxford),2012,14:604-610.DOI:10.1111/j.1477-2574.2012.00488.x.
2朱继业,高鹏骥.肝内胆管结石的外科治疗.中华普外科手术学杂志(电子版),2012,11:345-350.
3 Tomimaru Y,Eguchi H,Marubashi S,et al.Equivalent outcomes afteranatomical and non-anatomical resection of small hepatocellularcarcinoma in patients with preserved liver function.Dig Dis Sci,2012,57:1942-1948.
4王甸北,赵礼金,涂奎,等.解剖性肝切除术治疗肝内胆管结石的效果观察.临床肝胆病杂志,2017,33:102-105.
5朱卫东,谭兴国,邓如岗,等.精准肝切除技术在治疗右侧肝胆管结石中的应用.中国现代普通外科进展,2013,16:451-454.
6黄志强.肝内胆管结石治疗演变和发展.中国实用外科杂志,2015,35:468-470.
7 Jia CK,Weng J,Chen YK,et al.Hepatectomy with primary closure of common bile duct for hepatolithiasis combined with choledocholithiasis.World J Gastroenterol,2015,21:3564-3570.DOI:10.3748/wjg.v21.i12.3564.
8 Ran X,Yin B,Ma B.Four major factors contributing to intrahepatic stones.Gastroenterol Res Pract,2017,2017:7213043.DOI:10.1155/2017/7213043.
9 Shah OJ,Robbani I,Shah P,et al.Left-sided hepatic resection for hepatolithiasis:a longitudinal study of 110 patients.HPB(Oxford),2012,14:764-771.DOI:10.1111/j.1477-2574.2012.00534.
10中华医学会外科学分会胆道外科学组.肝内胆管结石病诊断治疗指南.中华消化外科杂志,2007,6:156-161.
11王坚.复杂肝内胆管结石的诊断与处理.中国实用外科杂志,2016,36:292-295.
12陈晓鹏,崔巍.精准外科时代胆管结石的诊断与治疗.肝胆胰外科杂志,2012,24:353-355.DOI:10.3969/j.issn.1007-1954.2012.05.001.
13刘付宝,王国斌,罗毅钊,等.精准肝脏外科理念在肝胆管结石病治疗中的临床价值.中华消化外科杂志,2014,13:447-451.DOI:10.3760/cma.j.issn.1673-9752.2014.06.009.
14 Lopes-Junior AG,Belebecha V,Jacob CE.Hepatectomy:a critical analysis on expansion of the indications.Arq Bras Cir Dig,2014,27:47-52.
15付宁,罗道蕴.规则肝切除在复杂肝内胆管结石治疗中的应用研究.成都医学院学报,2014,9:722-724.DOI:10.3969/j.issn.1674-2257.2014.06.019.
16刘思宇.多肝段切除治疗复杂肝内胆管结石临床分析.白求恩军医学院学报,2013,11:301-303.DOI:10.3969/j.issn.1672-2876.2013.04.008.
17钱言,孙礼侠.肝内胆管结石的外科治疗进展.医学研究杂志,2015,44:171-174.DOI:10.3969/j.issn.1673-548X.2015.03.050.
18唐诗彬,陈小伍,吴路杨,等.Glisson鞘解剖性肝切除术治疗肝内胆管结石.中华肝脏外科手术学电子杂志,2016,5:148-152.DOI:10.3877/cma.j.issn.2095-3232.2016.03.006.
19 Hyodo T,Kumano S,Kushihata F,et al.CT and MR cholangiography:advantages and pitfalls in perioperative evaluation of biliary tree.Br JRadiol,2012,85:887-896.DOI:10.1259/bjr/21209407.
20叶启文,林枫,张春,等.复杂肝内胆管结石326例个体化治疗.肝胆胰外科杂志,2014,26:356-358.
21金山.肝内胆管结石的病因及发病机制.世界华人消化杂志,2012,20:3324-3328.
22陈平,皮儒先.肝内胆管结石的外科治疗研究进展.中国普外基础与临床杂志,2014,21:1192-1193.DOI:10.7507/1007-9424.20140286.
23吴杨,黄强,胡元国,等.手术治疗复杂性肝内胆管结石的临床分析.肝胆外科杂志,2012,20:355-356.DOI:10.3969/j.issn.1006-4761.2012.05.012.
24周毅,胡亿龙,袁晟光,等.原发性肝内胆管结石的病因及外科治疗新进展.肝胆胰外科杂志,2016,28:351-352.DOI:10.11952/j.issn.1007-1954.2016.04.027.
25 Jarufe N,Figueroa E,Mu1oz C,et al.Anatomic hepatectomy as a definitive treatment for hepatolithiasis:a cohort study.HPB(Oxford),2012,14:604-610.DOI:10.1111/j.1477-2574.2012.00488.x.