急症肝切除治疗肝内胆管结石可行性分析

The feasibility of emergency hepatectomy in the treatment of hepatolithiasis

目的探讨急症肝切除治疗肝内胆管结石的可行性。方法回顾性研究了1 9 9 2年6月—1 9 9 9年6月急症肝切除治疗肝内胆管结石2 4例病人的临床资料,选择同时期2 4例首次手术为胆道引流,再择期行肝部分切除的肝内胆管病例作为对照组进行研究。比较两组手术并发症、手术病死率、治疗效果、胆道残余结石率、住院时间和治疗费用。结果两组病人在手术并发症、病死率、疗效优良率和残留结石率方面差异无显著性(P>0.0 5),但急症手术组在住院天数和治疗费用方面明显低于对照组(P<0.0 1)。结论对某些经过严格选择的合并急性胆管炎、重症急性胆管炎、胆源性肝脓疡、梗阻性黄疸和胆道大出血的肝内胆管结石患者,可酌情施行急症肝切除手术,以避免再次手术。

Objective To explore the feasibilty of emergency hepatectomy in the treatment of hepatolithiasis. Methods The clinical data of 24 patients with hepatolithiasis who underwent emergency hepatectomy and of 24 patients with hepatolithiasis who underwent secondary elective hepatectomy in our hospital from June 1992 to June 1999 （emergency hepatectomy group ） were retrospectively analyzed. Operative complications, mortality, efficacy of treatment, residual stone rate, days of hospitalization and medical expenses were compared between the two groups. Results There were no significant differences in the rate of operative complications, operative mortality, excellent treatment result rate and residual stone rate between the two groups （ all P 〉 0.05 ） . The days of hospitalization and medical expenses were markedly decreased （ P 〈 0.01 ） in the emergency hepatectomy group than those in the control group. Conchlsions For some strictly selected hepatolithiasis patients with severe complications, such as acute cholangitis , severe acute cholangitis, biliary hepatic abscess, obstructive jaundice and severe hemobilia, emergency hepatectomy may be considered to avoid reoperation.