贵州医科大学学报

2015, v.40;No.177(06) 619-622

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三种手术方式治疗肝内外胆管结石的疗效比较
Clinical Analysis of Partial Liver Resection Combined with Choledochoscope for Intrahepatic and Extrahepatic Bile Duct Stones

罗耀兵;江建新;潘耀振;孙诚谊;
LUO Yaobing;JIANG Jianxin;PAN Yaozhen;SUN Chengyi;Department of Hepatobiliary Surgery,Guizhou Medical University;

摘要(Abstract):

目的:比较肝部分切除联合胆道镜探查取石、胆总管切开取石"T"管引流以及胆管空肠Roux-en-Y吻合3种手术方式在治疗肝内外胆管结石中的临床疗效。方法:分析241例肝内外胆管结石患者的临床资料,比较肝部分切除联合胆道镜探查取石(A组)、胆总管切开取石"T"管引流(B组)以及胆管空肠Roux-en-Y吻合(C组)3种术式术后患者的结石残留率、结石复发率、胆管炎发生率以及再次手术率。结果:A组结石残留率(9.5%)低于B组(29.4%)和C组(38.2%),A组结石复发率(8.4%)低于B组(20.2%)和C组(22.2%),A组胆管炎发生率(7.2%)低于B组(19.1%)和C组(37%),A组再次手术率(2.4%)低于B组(13.1%)和C组(11.1%),差异均有统计学意义(P<0.05)。结论:肝部分切除术是治疗肝内外胆管结石有效的手术方式,联合应用胆道镜探查取石,可明显提高远期疗效。
Objective: To discuss and compare clinical efficacy of partial hepatectomy combined with choledochoscope for exploration and stone removal,choledochotomy for stone removal and T tube drainage and Roux-en-Y choledochojejunostomy in treating intra-and extrahepatic biliary duct stones.Methods: A total of 241 cases of patients with intra-and extrahepatic bile duct stones were enrolled in this study and divided into 3 goups: A group( partial hepatectomy combined with choledochoscope for exploration and stone removal),B group( choledochotomy for stone removal and T tube drainage),C group( Roux-en-Y choledochojejunostomy). The clinical data of 3 groups were analyzed retrospectively to compare rate of residual stone,rate stone recurrence,incidence of cholangitis and rate of reoperation. Results: The rate of residual stone in A group( 9. 5%) was lower than that in B group( 29. 4%) and C group( 38. 2%). The rate of stone recurrence in A group( 8. 4%) was lower than that in B groups( 20. 2%) and C group( 22. 2%). The incidence of cholangitis in A group( 7. 2%)was lower than that in B group( 19. 1%) and C group( 37%). The rate of reoperation in A group( 2. 4%) was lower than that in B group( 13. 1%) and C group( 11. 1%). All the differences were statistically significant( P < 0. 05). Conclusion: Partial hepatectomy is the most effective surgical procedure to treat the intra-and extrahepatic bile duct stones,whose clinical efficacy can be improved when combined with choledochoscope.

关键词(KeyWords): 肝切除术;胆道镜;手术方式;胆结石
partial hepatectomy;choledochoscope;operation mode;cholelithiasis

Abstract:

Keywords:

基金项目(Foundation): 省长资金临床应用课题专项研究[黔省合字(2012)94号];; 贵州省科技厅资助项目(TS2014-3)

作者(Author): 罗耀兵;江建新;潘耀振;孙诚谊;
LUO Yaobing;JIANG Jianxin;PAN Yaozhen;SUN Chengyi;Department of Hepatobiliary Surgery,Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2015.06.018

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