肝段或肝叶切除术对肝内胆管结石再次手术效果的影响

目的对比不同术式对肝内胆管结石再次手术效果，探讨肝段或肝叶切除术的优势。 方法回顾性分析2011年8月至2014年8月收治的79例肝内胆管结石再次手术患者资料，依据术式不同分为肝段(叶)切除术组(甲组，n＝38)和非肝段(叶)切除术组(乙组，n＝41)两组。应用SPSS 19.0软件对所有临床数据进行统计学分析，手术相关指标等以( ±s)的形式表示，组间比较采用独立t检验；术后并发症发生情况及预后情况等计数资料以例(%)的形式表示，采用χ²检验；P<0.05差异有统计学意义。 结果两组患者术中出血量、手术时间及术后住院时间相比，差异无统计学意义(P>0.05)；甲组患者的术后并发症发生率5.3%(2/38)显著低于乙组22.0%(9/41)(P<0.05)；甲组残留结石发生率、症状复发率2.6%(1/38)、 0(0/41)均显著低于乙组17.1%(7/41)、 12.2%(5/41)(P<0.05)，差异有统计学意义(P<0.05)；但两组患者的病死率2.6%(1/38)和0(0/41)相比，差异无统计学意义(P>0.05)。 结论肝段(叶)切除术能够有效改善肝内胆管结石再次手术效果，值得推广。

Influence of Hepatic Lobectomy and Segmental Resection on the Reoperative patients of Intrahepatic Bile Duct Stones

ObjectiveTo compare the reoperative effect of surgical procedures on intrahepatic bile duct stones and investigate the advantages of hepatic lobectomy and segmental resection. Methods79 reoperative cases of intrahepatic bile duct stones treated in our hospital from August 2011 to August 2014 were retrospectively analyzed, these patients were divided into hepatic lobectomy and segmental resection group (Group A, n=38) and non-hepatic lobectomy and segmental resection group (Group B, n=41) according to different surgical procedures. Statistical analysis were performed by using SPSS19.0, surgery related indicators were presented as and examined by using t test; postoperative complications and prognosis were examined by chi square. A P<0.05 was considered as significant difference. ResultsThere were no significant difference in blood loss, operation time and postoperative hospitalization time between the two groups (P>0.05). The postoperative complications rate of group A was significantly lower than group B (5.3% vs. 22.0%) (P<0.05), the incidence of residual stones, recurrence rate were significantly lower than group B (2.6% vs. 17.1%; 0 vs. 12.2%) (P<0.05), but there were no significant difference in mortality between the two groups (2.6% vs. 0) (P>0.05). ConclusionsThe hepatic lobectomy and segmental resection has good effects on the reoperative patients of intrahepatic bile duct stones, which is worth of promotion.