肝左外叶切除联合胆道镜治疗肝内外胆管结石效果的评价

Effect of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus

目的探讨左肝外叶切除联合胆道镜治疗肝内外胆管结石的效果。方法回顾性分析该院近10年来手术治疗的胆总管结石并左侧肝内胆管结石患者87例,其中胆总管切开取石加左外叶切除联合术中胆道镜46例(A组),胆总管切开取石加左外叶切除41例(B组)。比较两组的术后残石率、手术并发症和远期效果。结果 B组术后结石残余率(17.1﹪)明显高于A组(0﹪)(P<0.05)。两组术中出血量和手术时间及平均住院时间基本相同(P>0.05)。A组和B组术后总的并发症发生率分别为19.6%和19.5%,差异无显著性(P>0.05),A组的远期优良率大于B组(91.3%VS75.6%,P<0.05)。结论肝左外叶切除联合术中胆道镜治疗胆总管结石并左侧肝内胆管结石的短期和远期效果大于肝左外叶切除。

【Objective】 To summarize the effect of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus.【Methods】87 patients with hepatobiliary calculus who underwent hepatectomy were reviewed retrospectively,46 patients were undergone left lateral segmentectomy and section of common bile duct and calculus remove and combined with fiber choledochoscope（Group A）,41 patients were undergone left hepatectomy and section of common bile duct and calculus（Group B）.The postoperative stone residual rate,complications and long -term outcome were compared between these two groups.【Results】The postoperative stone residual rate of Groups B is 12.5%,were significantly higher than those of the group A（0%）,P 0.001.Intraoperative bleeding,operative times of the Group A and hospital stays of the Group A were same to those of the Group B（P 0.05）,There was no statistical significance of postoperative morbidity between these two groups（15.2% vs 24.4%,P 0.05）.The good satisfactory rate of two Group A is higher than that of the Group B（91.3% vs 82.9%,P 0.05）.【Conclusion】The long-term and the short-term outcome of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus is big to that of left hepatectomy.