左肝内胆管结石手术方式和时机选择

【摘要】〓目的〓研究左肝内胆管结石的手术方式和手术时机的选择。方法〓回顾性分析我科1995年1月至2014年12月手术治疗的78例左肝内胆管结石病例,比较不同时期的手术方法选择,比较不同手术方法的术后残石率、术后效果,以及急诊和择期切肝手术的差异。结果〓近10年左肝内胆管结石的肝切除率由10年前的21.9%升至87.0% (P=0.009),而且规则性左半肝切除率也由10年前0.0%增至54.3%(P<0.001)。切肝患者的术后残石率为12.8%,显著低于非切肝患者的67.7%(P=0.013),而且规则左半肝切除更能减少术后的残石率,由22.2%降至4.0%(P=0.026)。急诊切肝手术不仅增加手术时间、术中出血量、术后住院时间,而且术后并发症发生率高达56.5%,显著高于择期切肝的25.0%(P=0.036),术后残石率急诊切肝患者较择期切肝者显著升高(17.4% vs 8.3%, P=0.043)。结论〓左外叶肝切除以及规则性左半肝切除已是基层医院可以安全完成的手术。肝切除治疗左肝内胆管结石效果优于非肝切除手术,规则性左半肝切除治疗优于肝左外叶切除,急诊切肝风险大且效果不佳,应尽可能避免。

The selection and timing of surgery for left-sided hepatolithiasis

【Abstract】〓Objective〓To investigate the selection of the timing and methods of surgery for intrahepatic bile duct stones. Methods〓Between January 1995 and December 2014, 78 patients with left-sided hepatolithiasis were analyzed retrospectively in our hospital. This study focused on the choice of surgical methods and sugical opportunity, the complications, and long-term outcomes. Results〓Among the surgical modality, the hepatectomy was used for left-sided hepatolithiasis more generally this decade, compared with 10 years ago (87.0% vs 21.9%, P=0.009), in particular the regular left hepatectomy (54.3% vs 0.0%,(P<0.001)..The postoperative stone residual rate of hepatectomy group was significantly less than non-hepatectomy operations (67.7% vs 12.8%, P=0.013). Furthermore, the stone residual rate of regular left hepatectomy was remarkably lower than left lateral segmentectomy(22.2% vs 4.0%,P=0.026). In addition, emergency hepatectomy induced significantly more operative time,more volume of blood loss, more length of postoperative hospital stay, higher frequency of procedure-related complications, and higher postoperative stone residual rate(17.4% vs 8.3%,P=0.043),compared with selective hepatectomy. Conclusion〓As the safe and effective technique in our primary hospital, the outcome of hepatectomy for left-sided hepatolithiasis is markedly superior to non-hepatectomy operations.Moreover,regular left hepatectomy is better than left lateral segmentectomy. It is notable that emergency hepatectomy is very dangerous and has poor outcomes. So emergency hepatectomy should be avoided as far as possible.