肝内胆管结石合并急性胆管炎患者的最佳手术治疗时间探讨

THE OPTIMAL TIMING OF HEPATECTOMY FOR HEPATOLITHIASIS COMPLICATED WITH ACUTE CHOLANGITIS

目的探讨肝内胆管结石合并急性胆管炎患者的肝切除最佳手术时机。方法回顾性分析近3年肝内胆管结石合并急性胆管炎104例患者的临床资料,根据肝切除时距最近一次急性胆管炎控制后的时间间隔分为3组。A组,炎症控制后1个月内手术(n=30);B组,炎症控制后1～3个月内手术(n=36);C组,炎症控制后≥3个月手术(n=38)。比较3组患者手术时间、术中出血量、平均住院时间、术后并发症和结石残留等。结果炎症控制后1个月内手术患者的输血量和需输血例数亦显著高于炎症控制后>1个月手术患者;术后并发症发生率、术后残石率和住院时间均高(P<0.01)。结论肝内胆管结石合并急性胆管炎患者炎症控制后≥1个月为肝切除时机。

Objective To evaluate the optimal timing of hepatectomy for intrahepatic lithiasis complicated with acute cholangitis. Methods One hundred and four patients with hepatoiithiasis who had a history of acute cholangitis and underwent hepatectomy were reviewed retrospectively. According to the period between the surgery and last attack of acute cholangitis, 104 patients were divided into 3 groups,〈1 month（group A, n =30）,1-3 cnonths（group B, 7l = 36）,）3 months（group C, n = 38）. The operation time, blood loss, hospital stay, postoperative complications and stone residual rate were compared among the groups. Results The numbers of patients who needed transfusion and the amount of blood transfusion in group A were higher than those of group B and C. The incidence rate of complications, residual stone in group A were all markedly higher than those of group B and C. The period of hospital stay in group A was much longer than that in group B and C. Conclusion The optimal timing of hepatectomy for hepatolithiasis complicated with acute cholangitis is at least one month after subsidence of cholangitis.