肝内胆管结石合并急性胆管炎的肝切除时机

目的探讨肝内胆管结石合并急性胆管炎的肝切除最佳手术时机。方法回顾性分析我院近5年肝切除治疗有胆管炎发作病史的126例肝内胆管结石患者的临床资料。根据肝切除时离最近一次急性胆管炎控制后的时间间隔分为3组。A组:炎症控制后≥3个月手术(n=73);B组:炎症控制后≥1个月、<3个月手术(n=28);C组:炎症控制后1个月内手术(n=25)。比较三组患者手术时间、术中出血量、平均住院时间、术后并发症和结石残留率等。结果C组患者术中出血量为(644·0±625·7)ml,明显高于A组的(409·2±250·7)ml和B组的(423·2±237·1)ml,C组的输血量和需输血人数亦显著高于A组和B组。C组术后并发症发生率、术后残石率和住院时间均显著高于A组和B组。结论肝内胆管结石合并急性胆管炎炎症控制后的肝切除时机为炎症控制后≥1个月。

The timing of hepatectomy for hepatolithiasis complicated with acute cholangitis

OBJECTIVE: To evaluate the optimal timing of hepatectomy for intrahepatic lithiasis complicated with acute cholangitis. METHODS: One hundred and twenty-six patients with hepatolithiasis who had a history of acute cholangitis and underwent hepatectomy were reviewed retrospectively. According to the period between the surgery and last attack of acute cholangitis, 126 patients were divided into 3 groups: > 3 months (group A, n = 73), 1 approximately 3 months (group B, n = 28), < 1 month (group C, n = 25). The operation time, blood loss, hospital stay, postoperative complications and stone residual rate were compared among the groups. RESULTS: The intraoperative blood loss of C group was (644.0 +/- 625.7) ml, which was significantly higher than those of A and B group [(409.2 +/- 250.7) ml and (423.2 +/- 237.1) ml, respectively]. The numbers of patients who needed transfusion and the amount of blood transfusion in group C were also higher than those of group A and B. The incidence rate of complications, residual stone in group C were all markedly higher than those of group A and B. The period of hospital stay in group C was much longer than that in group A and B. CONCLUSIONS: The optimal timing of hepatectomy for hepatolithiasis complicated with acute cholangitis is at least one month after subsidence of cholangitis.