解剖性肝切除治疗肝胆管结石的疗效分析

发布时间：2018-05-28 21:39

本文选题：肝胆管结石 + 肝切除术　；参考：《安徽医科大学》2015年硕士论文

【摘要】：目的:比较解剖性规则肝切除与非解剖性规则肝切除治疗肝胆管结石病的疗效。方法:回顾性分析了安徽医科大学附属安徽省立医院自2008年2月至2014年6月1日收治的168例肝叶切除术治疗肝胆管结石病的患者。其中110例行传统的非解剖性规则肝叶切除,58例行的解剖性规则肝切除。比较两组的手术所用时间、术中出血量、断肝出血量、术后的并发症发生率、术后3天的肝功能指标、手术后的住院时间、住院所需总费用、术后结石的残留率以及结石的复发率。结果:两组患者的一般情况、有无基础疾病、结石的分布情况、胆管的变异情况及切肝范围均无统计学差异(P0.05),具有可比性。两组手术患者均无围手术期死亡,出院后被告知定期复查,所有患者经过1至7年的有效随访。解剖性规则肝切除组手术时间为228.11±66.78min,术中出血量为402.86±329.09ml,断肝出血量为158.17±87.9ml,术后第3天谷丙转氨酶为169.41±68.26IU/L、总胆红素为58.12±13.45umol/L、血清白蛋白为30.33±7.89g/L,手术过后有6位患者出现了并发症(其中包括2例出现胆漏、3例出现胸腔积液、1例出现切口感染),术后总的住院日为7.63±3.52天,住院所需的总费用为29466±10494元,术后2位患者结石残留,1位患者结石复发。非解剖性规则肝切除组时间为198.11±56.89min,术中出血量为501.78±288.12ml,断肝出血量为188.11±78.2ml,术后第3天谷丙转氨酶为211.52±78.26IU/L、总胆红素为61.32±15.11umol/L、血清白蛋白为28.01±6.12g/L,有位32患者出现并发症(包括16例胆漏、12例胸腔积液、1例腹腔出血及3例切口感染),术后住院日为8.82±4.14天,住院总费用为28466±10899元,术后20位患者结石残留,18位患者结石复发。与非解剖性规则肝切除组相比,解剖性规则肝切除组手术中的出血量、断肝的出血量、手术过后的并发症发生率、手术后的结石残留率以及结石复发率均显著降低(P0.05),解剖性规则肝切除组较非解剖性规则肝切除组的手术时间有明显的延长(P0.05)。解剖性规则肝切除组的手术过后的3天谷丙转氨酶指标较非解剖性规则肝切除组有了明显的降低(P0.05),然而两个手术组的血总胆红素水平及血清白蛋白水平却无统计学的差异(P0.05)。术后两组患者的住院时间及住院总费用也无统计学差异(P0.05)。结论:解剖性规则肝切除能够彻底的清除结石和病灶,降低结石的残留率及复发率,减少术后并发症的发生率,虽然手术时间较长,技术难度大,但值得进一步推广。
[Abstract]:Objective: to compare the effect of anatomical regular hepatectomy and non anatomical hepatectomy on hepatolithiasis. Methods: 168 cases of hepatobiliary lithiasis treated in Anhui Provincial Hospital affiliated to Anhui Medical University from February 2008 to June 1 2014 were analyzed retrospectively. 110 cases were treated with traditional non-anatomical regular liver lobectomy and 58 cases with anatomical regular hepatectomy. The time of operation, the amount of blood lost during operation, the incidence of postoperative complications, the indexes of liver function 3 days after operation, the hospitalization time after operation, the total cost of hospitalization were compared between the two groups. The residual rate of stone and the recurrence rate of stone after operation. Results: there was no statistical difference between the two groups in the general condition, whether there were basic diseases, the distribution of stones, the variation of bile duct and the scope of hepatectomy. There were no perioperative deaths in both groups and were informed of regular reexamination after discharge. All patients were followed up for 1 to 7 years. In the anatomical regular hepatectomy group, the operative time was 228.11 卤66.78 min, the intraoperative bleeding was 402.86 卤329.09 ml, the blood loss was 158.17 卤87.9 ml, the total bilirubin was 58.12 卤13.45 渭 mol / L, the total bilirubin was 58.12 卤13.45 渭 mol / L and the serum albumin was 30.33 卤7.89 g / L. Among them, 2 cases had bile leakage, 3 cases had pleural effusion and 1 case had incisional infection. The total hospital stay after operation was 7.63 卤3.52 days. The total cost of hospitalization was 29466 卤10494 yuan. In the non-anatomical regular hepatectomy group, the time was 198.11 卤56.89 min, the intraoperative bleeding was 501.78 卤288.12 ml, the blood loss was 188.11 卤78.2 ml, the third day after operation was 211.52 卤78.26 IU / L, 61.32 卤15.11 渭 mol / L, and 28.01 卤6.12 g / L, respectively. Complications occurred in 32 patients (including 16 cases of biliary leakage). 12 cases with pleural effusion and 1 case with intraperitoneal hemorrhage and 3 cases with incision infection were admitted to hospital for 8.82 卤4.14 days after operation. The total cost of hospitalization was 28466 卤10899 yuan. Compared with the non-anatomical regular hepatectomy group, the amount of blood lost in the operation, the amount of blood lost in the dissection regular hepatectomy group, and the incidence of complications after the operation were found in the anatomical regular hepatectomy group. The residual rate and recurrence rate of stones decreased significantly after operation, and the operative time in the anatomical regular hepatectomy group was significantly longer than that in the non-anatomical regular hepatectomy group. The levels of serum total bilirubin and serum albumin in the anatomic regular hepatectomy group were significantly lower than those in the non-anatomical regular hepatectomy group on the 3rd day after operation (P 0.05), however, there was no significant difference between the two groups in the level of total bilirubin and serum albumin. There was no significant difference in the length of stay and total cost of hospitalization between the two groups (P 0.05). Conclusion: anatomical regular hepatectomy can thoroughly remove stones and lesions, reduce the residual rate and recurrence rate of stones, and reduce the incidence of postoperative complications. Although the operative time is longer and the technique is difficult, it is worth further popularizing.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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