不同范围肝切除术对肝内胆管结石的治疗效果分析

The treatment effect analysi of liver resection and different range liver resection on intrahepatic bile duct calculus

目的分析肝切除和不同范围肝切除术对肝内胆管结石的治疗效果。方法选取本院2003年12月～2012年12月手术治疗的肝内胆管结石患者452例,比较肝切除组、无肝切除组以及不同范围肝切除组手术后的结石残余率、治疗优良率以及手术并发症。结果肝切除组术后残余结石率、优良率优于无肝切除组(P<0.05),但肝切除组术后的并发症(伤口并发症不计)与无肝切除者差异无统计学意义(P>0.05)。局限在肝左外叶的结石,肝左外叶切除术后无残余结石患者。但对于结石超过左外叶时,左、右半肝切除以及肝段切除残余结石率、优良率优于左外叶切除术后(P<0.05)。左外叶切除并发症(伤口并发症不计)低于左右半肝切除和肝段切除(P<0.05)。结论肝切除治疗肝内胆管结石优于不进行肝切除,对于超出左外叶的肝内胆管结石,半肝切除和肝段切除术治疗效果优于仅仅左外叶切除。

Objective To analyze the treatment effect of liver resection and different range liver resection on intrahepatic bile duct calculus. Methods Four hundred and fifty-two of patients with intrahepatic bile duct calculus during the period from December 2003 to December 2012 were analyzed. The postoperative stone residual rate, treatment success rates and complications surgery of liver excision group, without liver excision group and different range liver excision group were compared. Results The postoperative stone residual rate of liver excision group was Superior to that of without liver excision group （P 〈 0.05）. But there were not statistical differences （P 〉 0.05） between postoperative complication （regardless of the wound complications） of liver resection operation group and that without liver resection. There were not any residual stones after operation of liver resection of the left outside leaf for the patients with calculus, which were insofar as the left outside leaf of liver. But for the patients with calculus which were exceeded the range of left outside leaf, the residual stones rate, the success rate of right, left half liver resection and liver resection were superior to those of the left outside leaf resection（P 〈 0.05）. The complication of left outside leaf resection was inferior to that of right, left half liver resection and liver resection （P 〈 0.05）. Conclusion It is better to treat intrahepatic bile duct calculus with liver resection than without liver resection. For the intrahepatic bile duct calculus which exceeded the left outside leaf of liver, the treatment effects of half liver resection and liver resection are superior to that just left outside leaf liver resection.