肝胆管结石伴胆管狭窄的肝段肝切除与非肝段肝切除的疗效比较

Clinical results of surgical treatment with or without hepatic segmentectomy in patients suffering from intrahepatic cholelith complicated by bile duct stricture

目的探讨肝段肝切除和非肝段肝切除两种常用的联合手术治疗肝胆管结石伴狭窄的效果。方法对1983年6月～1993年6月手术治疗的肝内胆管结石105例进行分析,其中双侧、左侧及右侧肝内胆管结石分别为57例(54.3%)、39例(37.1%)、9例(8.6%),合并肝内胆管狭窄70例(66.7%)。全部病例分为两组:前5年一组50例,采用非肝段肝切除联合手术治疗(下称非肝段切除组);后5年一组55例,采用肝段肝切除联合手术治疗(称肝段切除组)。结果 90例随访2～10年,肝段切除组优良46例(92%),非肝段切除组失访15例,优良32例(80%)。肝段切除组较非肝段切除组术后残石率低(8%:25%,P<0.05);症状复发率低(14%:35%,P<0.05);再手术率低(0%:12.5%,P<0.05)。结论肝段肝切除的联合手术能有效降低术后残石发生、症状复发和再手术率,是当前治疗肝胆管结石伴狭窄的首选术式。

Objective To evaluate the effects of surgical treatment with or without hepatic segmentectomy in patients with intrahepatie cholelith complicated by bile duct stricture.Method 105 cases of intrahepatic cholelith with bile duct stricture admitted from June 1983 to June 1993 were reviewed.Among them bilateral hepatic cholelith, left cholelith and right cholelith were found in 57(54.28 % ),39(37.14% )and 9(8.57%),respectively.Seven- ty cases were complicated by bile duct stricture.Patients(50 cases) admitted during the first 5 years were treat- ed without hepatic segmentectomy,and those(55 cases)admitted during the recent 5 years with hepatic seg- mentectomy.Results A total of 90 cases were followed up from 2 to 10 years.Good to excellent result was found in 46 cases(92%)in the second group while it was only 80%(32 cases)in the first group.The rate of residual stone,symptom recurrence,and rate of reoperation was 8% vs 25%(P<0.05),14% vs 35%(P< 0.05),and 0% vs 12.5(P<0.05),respectively.Conclusion In cases of intrahepatic cholelith complicated by bile duct stricture surgery combined with hepatic segmentectomy should be the therapy of choice.