临床研究(Clinical Research)

基于区段肝蒂的肝切除术在肝胆管结石手术中的应用

Published at: 2017年第26卷第8期

蔡云峰 1 , 苏树英 1 , 许卓明 1 , 叶智明 1 , 张耿 1 , 张萦斐 1
1 中山大学附属佛山医院 胆道外科,广东 佛山 528000
通讯作者 云峰 蔡 Email: cyunfeng@fsyyy.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.08.008
基金:
广东省佛山市医学类科技攻关基金资助项目 2014AB00266

摘要

目的:探讨基于区段肝蒂的肝切除术治疗肝胆管结石的手术效果。方法:采用前瞻性病例对照研究,将90例肝胆管结石患者随机分为研究组和对照组,每组各45例,研究组行基于区段肝蒂的肝切除术,对照组采用B超定位的基于Couinaud肝叶段划分方法的肝切除术,比较两组患者的相关临床指标。结果:两组患者的一般情况、术前肝功能、结石分布、胆管变异和切肝范围均无统计学差异(均P>0.05)。研究组较对照组的术中出血量、术后并发症发生率、引流量及术后结石残留率均明显降低(均P<0.05),手术时间、输血率、术后肝功能改变、术后排气时间、术后住院时间两组间比较无统计学差异(均P>0.05)。结论:基于区段肝蒂的肝切除术具有出血量少,术后渗出及并发症少、结石残留率低等优点,适合在肝胆管结石肝切除手术中应用。


Application of hepatectomy based on pedicles of hepatic segments in treatment of hepatolithiasis

Abstract

Objective: To investigate the efficacy of liver resection based on pedicles of hepatic segments in treatment of hepatolithiasis. Methods: Using a prospective, cohort-controlled design, 90 patients with hepatolithiasis were randomly designated to study group and control group, with 45 cases in each group. Patients in study group underwent hepatectomy based on pedicles of hepatic segments and those in control group underwent hepatectomy based on Couinaud’s liver segment classification under ultrasound positioning. The main clinical variables between the two groups of patients were compared. Results: The general condition, liver function, stone distribution, bile duct variations and scope of liver resection showed no statistical difference between the two groups of patients before operation (all P>0.05). The intraoperative blood loss, incidence of postoperative complications, drainage volume and residual stone rate were significantly reduced in study group compared with control group (all P<0.05). The differences in operative time, blood transfusion rate, postoperative liver function, time to postoperative gas passage, and length of postoperative hospital stay showed no statistical significance (all P>0.05). Conclusion: Hepatectomy based on pedicles of hepatic segments has the advantages of small amount of blood loss and exudation as well as low rate of complications and residual stones, so it suitable to be used in treatment of hepatolithiasis.


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引用

引用本文: 云峰 蔡, 树英 苏, 卓明 许, 智明 叶, 耿 张, 萦斐 张. 基于区段肝蒂的肝切除术在肝胆管结石手术中的应用 [J]. 中国普通外科杂志, 2017, 26(8): 1001-1006.
Cite this article as: CAI Yunfeng, SU Shuying, XU Zhuoming, YE Zhiming, ZHANG Geng, ZHANG Yingfei . Application of hepatectomy based on pedicles of hepatic segments in treatment of hepatolithiasis [J]. Chin J Gen Surg, 2017, 26(8): 1001-1006.