左半肝切除与肝左外叶切除治疗左侧肝内结石的效果比较

THE COMPARISON OF LONG-TERM OUTCOME BETWEEN LEFT HEPATECTOMY AND LEFT LATERAL SEGMENTECTOMY FOR LOCALIZED LEFT-SIDE INTRAHEPATIC LITHIASIS

目的比较左半肝切除与肝左外叶切除治疗左侧肝内结石的效果。方法回顾性分析我科近14年来手术切除的结石局限在左侧肝内的肝内结石患者96例,其中左外叶切除61例,为左外叶切除组,左半肝切除35例,为左半肝切除组。比较两组的术后残石率、手术并发症和远期效果。结果左外叶切除组术后结石残余率为13．1％,明显高于左半肝切除组(0％), P=0．025(Fisher exact test)。左外叶切除组术中出血量(P=0．005)和手术时间(P=0．017)均明显低于左半肝切除组,左外叶切除组的平均住院时间短于左半肝切除组,但无统计学差异(P=0．057)。左外叶切除组和左半肝切除组术后总的并发症发生率分别为19．7％和31．4％,P=0．220。左半肝切除组的远期优良率显著高于左外叶切除组(78．8％vs 96．8％,P=0．027)。结论左半肝切除治疗左侧肝内结石的短期和远期效果明显优于肝左外叶切除,对于局限在左侧肝内的胆管结石,应行左半肝切除。

Objective To compare the long-term outcome of left hepateetomy and left lateral segmentectomy for leftside intrahepatic lithiasis. Methods 96 patients with localized left-side intrahepatic lithiasis who underwent hepatectomy were reviewed retrospectively. 61 patietns were unergone left lateral segmentectomy（LLS）,which was the LIS group. 35 patients were undergone left hepateetomy（LH）,which was the LH group. The postoperative stone residual rate,complications and long-term outcome were compared between these two groups. Result the postoperative stone residual rate of the LLS group was significant higher than that of LH group （13. 1% vs 0% ,P= 0. 025,Fisher exact test）. Intraoperative bleeding（P=0. 005 ）,operative times （P= 0. 017）and hospital stays （P= 0. 057） of the LH group was greater than those of the LLS group. There was no statistical significance of postoperative morbidity between these two groups （19.7 % vs 31.4 %,P = 0. 220）. The good satisfactory rate of I.H group was significant better than that of LLS group（96.8% vs 78. 8% ,P=0.027）. Conclusion the long-term outcome of left hepateetomy is superior than that of left lateral segmenteetomy for localized left-side intrahepatic lithiasis ,and for these patients,left hepateetomy is indicated.