解剖法与非解剖法肝切除在肝胆管结石治疗中的应用与近期效果分析

目的:比较解剖法与非解剖法肝切除治疗肝胆管结石的手术效果。方法:采用前瞻性病例对照研究,其中解剖法肝切除31例,非解剖法肝切除30例,比较两组患者的手术时间、术中出血量、术后并发症发生率、谷草转氨酶(AST)、引流量、排气时间、术后住院时间和结石残留率。结果:两组患者一般情况、脏器功能、结石分布、解剖变异和切肝范围均无统计学差异(均P>0.05),具有可比性。与非解剖法肝切除组比较,解剖法肝切除组术中出血量、术后并发症发生率、引流量均明显降低(均P<0.05),手术时间延长(P<0.05);术后排气时间、术后住院时间和结石残留率两组间差异无统计学意义(均P>0.05)。结论:解剖法肝切除具有手术打击小,术后渗出及并发症少等优点,虽然手术时间较长,但仍有改进潜力,值得推广。

Application and effects analysis of anatomical and nonanatomical hepatectomy for hepatolithiasis

Objective: To compare the efficacies of anatomic and nonanatomic hepatectomy for hepatolithiasis. Methods: The clinical data of 61 patients with hepatolithiasis undergoing hepatectomies were retrospectively analysed.Using a prospective,cohort-controlled design,31 patients with hepatolithiasis underwent anatomic hepatectomy and the other 30 patients with hepatolithiasis underwent nonanatomic hepatectomy.The operative time,intraoperative blood loss,incidence of postoperative complications,postoperative aspartate transaminase(AST) level,postoperative drainage volume,time to flatus,length of postoperative hospitalization and residual stone rate of the two groups were compared. Results: There were no significant differences in the general condition,organs function,stone distribution,anatomic variation and scope of liver resection between the two groups before operation(all P>0.05).The intraoperative blood loss,incidence of postoperative complications,AST level and drainage volume were significantly reduced but the operative time was significantly prolonged in anatomic hepatectomy group compared with nonanatomic hepatectomy group(all P<0.05).No differences between the two groups were noted with regard to the time span for flatus,length of postoperative hospital stay and residual stone rate(all P>0.05). Conclusion: Anatomic hepatectomy has the advantages of minimum surgical trauma as well as reduced exudation and less complications.Although it currently requires longer operative time than nonanatomic procedure,its potentiality for improvement is possible.So it deserves to be widely performed.