解剖性肝切除治疗区域型肝内胆管结石的近期及远期疗效评价

The recent and long-term effects of anatomical hepatectomy and non-anatomical hepatectomy for regional hepatolithiasis

目的评价解剖性肝切除治疗区域型肝内胆管结石的近期及远期疗效。方法回顾性分析2013年6月至2015年6月86例区域型肝内胆管结石患者的临床资料,根据手术方式不同分为解剖性肝切除组40例和非解剖性肝切除组46例,采用SPSS 19.0软件进行统计学分析,手术相关指标及术后恢复指标以(±s)表示,采用独立t检验;术后并发症发生率比较采用χ~2检验,结石复发率根据Kaplan-meier法计算并绘制无结石复发生存曲线,P<0.05为差异有统计学意义。结果解剖性肝切除组术中出血量(426.7±23.5)ml及患者住院时间(7.2±0.4)d均明显少于非解剖性肝切除组(673.1±48.5)ml及(8.3±0.9)d,组间差异有统计学意义(P<0.05)。解剖性肝切除组患者术后胆漏、切面感染及结石复发的发生均明显少于非解剖性肝切除组,差异有统计学意义(P<0.05)。86例患者均随访到术后24个月,解剖性肝切除组有1例患者(2.5%)术后13个月发生了结石残留,非解剖性肝切除组术后有18例患者(39.1%)发生了结石残留,差异有统计学意义(P<0.05)。结论解剖性肝切除这种符合肝脏生理结构的外科切除更能够减少患者术中出血量,缩短患者住院时间,防止结石复发。

Objective To evaluate the recent and long-term effects of anatomical hepatectomy and non-anatomical hepatectomy for regional hepatolithiasis. Methods Retrospective analysis of forty hospitalized anatomical hepatectomy patients and forty-six non-anatomical hepatectomy patients from June 2013 to June 2015.Statistical analysis was performed by using SPSS19. 0 software. Measurement data were expressed as and were compared by student＇s t test,the recurrence rate of the stones was calculated according to kaplan-meier method to drawn the survival curve,and the survival rate was compared with the Log-rank test. Post-operative complication rate was compared by chi-square test. P less than 0. 05 was considered as significant difference. Results The intra-operative blood,hospital stays postoperative biliary leakage,surface infection and recurrence of stones in anatomical hepatectomy group were significantly less than the non-anatomical hepatectomy group,the difference was statistically significant（P〈0. 05）. 86 patients were followed up for 24 months,one patient（2. 5%） in the anatomical hepatectomy group had stone residue 13 months after surgery,while 18 patients（39. 1%） in the non-anatomical hepatectomy group,the difference was statistically significant（ P〈0. 05）. Conclusion Anatomical hepatectomy which is in accordance with the physiological structure of the liver can reduce the intra-operative blood,hospital stays and prevent the recurrence of stones.