肝左外叶切除联合胆道镜取石术治疗左肝内胆管结石的临床研究

Clinical research of left hepatolithiasis treated by left-sided hepatic lobe resection combined with choledochoscope lithotomy

目的探讨肝左外叶切除联合胆道镜取石术治疗左肝内胆管结石的临床效果。方法回顾性分析2009年1月—2013年12月我院收治的60例左肝内胆管结石患者的临床资料,其中接受肝左外叶切除联合胆道镜取石术者30例作为观察组;接受左半肝切除术者30例作为对照组。对比两组患者的术中出血量、手术时间、术后并发症及近期疗效。计数资料采用χ2检验或Fisher确切概率法,计量资料采用t检验,以P<0.05表示差异具有统计学意义。结果观察组和对照组的术中出血量分别为[(371.54±167.65)、(508.97±203.65)ml]、手术时间[(188.45±39.76)、(237.67±40.37)min]、术后并发症发生率(10.00%、30.00%),观察组明显低于对照组,差异具有统计学意义(t=-1.938、-2.127,χ2=4.038,均P<0.05);观察组和对照组术后结石残余率(6.67%)和治疗优良率(92.59%、92.00%)比较差异无统计学意义(χ2=0.045、0.023,均P>0.05)。结论左外叶切除联合胆道镜取石术治疗左肝内胆管结石安全、有效,值得临床推广应用。

Objective To investigate the clinical efficacy of left -sided hepatolithiasis treated by left hepatic lobe resection combined with choledochotcopic lithotomy. Methods retrospective analysis was conducted on the clinical data of 60 cases of left hepatolithiasis from January 2009 to December 2013. 30 cases undergoing left hepatic lobe resection combined choledochoscope lithotomy were as observation group, while 30 cases receiving left liver resection were as control group. Both groups were compared for intraoperative blood loss, operative time, postoperative complications and short -term efficacy. Х^2 test or Fisher＇s exact test was used for count data, t - test for measurement data, P 〈 0. 05 was considered statistically significant. Results The amount of intraoperative blood loss was （ 371.54 ± 1 67.65 ） ml and （ 508.97 ± 203.65 ） ml respectively in observation group and control group; operation time was（ 188.45 ± 39.76） min and （237.67 ± 40.37）min respectively in observation group and control group ; the incidence of postoperative complications was 10.00% and 30.00% respectively in observation group and control group; intraoperative blood loss, operative time, postoperative complications were significantly lower in observation group than in control group, which showed statistically significant difference（ t = - 1. 938, t = - 2. 127, Х^2= 4. 038, P〈 0.05 ）. The incidence of postoperative residual stones was 6.67% and 0% respectively in observation group and control group; and the excellent rate of treatment was 92.59% and 92.0% respectively in observation group and control group,there was no statistically significant difference （Х^2 = 0.045, 0.023, P 〉 0. 05 ）. Conclusions Left hepatic lobe rection combined wit.h eholedochoscope lithotomy for left hepatolithiasis is safe, effective, and worthy of clinical application.