部分肝切除术与胆肠吻合术治疗肝内胆管结石的效果比较(附1025例分析)

目的 总结并评价部分肝切除术在治疗肝内胆管结石病中的价值.方法 回顾性分析1995年1月～2009年12月我院1025例肝内胆管结石的术后并发症、结石残留率及复发率的情况,评价部分肝切除术在治疗肝内胆管结石病中的安全性和有效性.结果 本组1025例中687例(67.02％)行部分肝切除术,338例(22.98％)单纯行胆肠吻合术.术后并发腹腔感染53例(5.17％),胆漏34例(3.32％),胆道出血7例(0.68％),重症急性胆管炎7例(0.68％),术后死亡5例(0.49％).行部分肝切除术组并发症的发生率与单纯行胆肠吻合术组比较差异无统计学意义(P＞0.05).两手术组结石残留率分别为6.11％和19.82％,结石复发率分别为18.63％和33.43％,部分肝切除术组的结石残留率和复发率均显著低于单纯行胆肠吻合术组(P＜0.05).结论 部分肝切除术是治疗肝内胆管结石的安全、有效的手段,具有良好的近、远期疗效.

Effect of Partial Hepatectomy and Bile Buct Intestinal Anastomosis in the Treatment of 1025 Patients with Hepatolithiasis

Objective To assess the values of regular hepatic resection for hepatolithiasis.Methods One thousand and twenty five patients with hepatolithiasis were enrolled during January 1995 and December 2009.Patients were divided into two groups.partial hepatectomy group and cholangio-jejunostomy group,according to the surgery procedures.The rates of postoperative complication,stone residue and stone recurrence were retrospectively analyzed.Results Among 1025 patients,687(67.02%) patients underwent partial hepatectomy,338 patients(22.98%) underwent bile buct intestinal Anastomosis.The main complications were peritoneal infection(5.17%),biliary fistulas(3.32%),biliary bleeding(0.68%) and severe acute cholangititis(0.68%).The operative mortality rate was 0.49%.The occurrence rates of postoperative complications in the two groups were not significantly different from each other(P>0.05).However,the stone residue and recurrence rates in partial hepatectomy group were significantly lower than those in cholangio-jejunostomy group(6.11% versus 19.82%,and 18.63% versus 33.43%,respectively),P<0.05.Conclusion Partial hepatic resection is a safe and effective method for hepatolithiasis treatment,with satisfactory outcomes both in short and long-term.