本文選題：肝膽管結(jié)石 + 肝切除術(shù)　； 參考：《安徽醫(yī)科大學》2015年碩士論文

【摘要】：目的:比較解剖性規(guī)則肝切除與非解剖性規(guī)則肝切除治療肝膽管結(jié)石病的療效。方法:回顧性分析了安徽醫(yī)科大學附屬安徽省立醫(yī)院自2008年2月至2014年6月1日收治的168例肝葉切除術(shù)治療肝膽管結(jié)石病的患者。其中110例行傳統(tǒng)的非解剖性規(guī)則肝葉切除,58例行的解剖性規(guī)則肝切除。比較兩組的手術(shù)所用時間、術(shù)中出血量、斷肝出血量、術(shù)后的并發(fā)癥發(fā)生率、術(shù)后3天的肝功能指標、手術(shù)后的住院時間、住院所需總費用、術(shù)后結(jié)石的殘留率以及結(jié)石的復發(fā)率。結(jié)果:兩組患者的一般情況、有無基礎疾病、結(jié)石的分布情況、膽管的變異情況及切肝范圍均無統(tǒng)計學差異(P0.05),具有可比性。兩組手術(shù)患者均無圍手術(shù)期死亡,出院后被告知定期復查,所有患者經(jīng)過1至7年的有效隨訪。解剖性規(guī)則肝切除組手術(shù)時間為228.11±66.78min,術(shù)中出血量為402.86±329.09ml,斷肝出血量為158.17±87.9ml,術(shù)后第3天谷丙轉(zhuǎn)氨酶為169.41±68.26IU/L、總膽紅素為58.12±13.45umol/L、血清白蛋白為30.33±7.89g/L,手術(shù)過后有6位患者出現(xiàn)了并發(fā)癥(其中包括2例出現(xiàn)膽漏、3例出現(xiàn)胸腔積液、1例出現(xiàn)切口感染),術(shù)后總的住院日為7.63±3.52天,住院所需的總費用為29466±10494元,術(shù)后2位患者結(jié)石殘留,1位患者結(jié)石復發(fā)。非解剖性規(guī)則肝切除組時間為198.11±56.89min,術(shù)中出血量為501.78±288.12ml,斷肝出血量為188.11±78.2ml,術(shù)后第3天谷丙轉(zhuǎn)氨酶為211.52±78.26IU/L、總膽紅素為61.32±15.11umol/L、血清白蛋白為28.01±6.12g/L,有位32患者出現(xiàn)并發(fā)癥(包括16例膽漏、12例胸腔積液、1例腹腔出血及3例切口感染),術(shù)后住院日為8.82±4.14天,住院總費用為28466±10899元,術(shù)后20位患者結(jié)石殘留,18位患者結(jié)石復發(fā)。與非解剖性規(guī)則肝切除組相比,解剖性規(guī)則肝切除組手術(shù)中的出血量、斷肝的出血量、手術(shù)過后的并發(fā)癥發(fā)生率、手術(shù)后的結(jié)石殘留率以及結(jié)石復發(fā)率均顯著降低(P0.05),解剖性規(guī)則肝切除組較非解剖性規(guī)則肝切除組的手術(shù)時間有明顯的延長(P0.05)。解剖性規(guī)則肝切除組的手術(shù)過后的3天谷丙轉(zhuǎn)氨酶指標較非解剖性規(guī)則肝切除組有了明顯的降低(P0.05),然而兩個手術(shù)組的血總膽紅素水平及血清白蛋白水平卻無統(tǒng)計學的差異(P0.05)。術(shù)后兩組患者的住院時間及住院總費用也無統(tǒng)計學差異(P0.05)。結(jié)論:解剖性規(guī)則肝切除能夠徹底的清除結(jié)石和病灶,降低結(jié)石的殘留率及復發(fā)率,減少術(shù)后并發(fā)癥的發(fā)生率,雖然手術(shù)時間較長,技術(shù)難度大,但值得進一步推廣。
[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 鹵66.78 min, the intraoperative bleeding was 402.86 鹵329.09 ml, the blood loss was 158.17 鹵87.9 ml, the total bilirubin was 58.12 鹵13.45 渭 mol / L, the total bilirubin was 58.12 鹵13.45 渭 mol / L and the serum albumin was 30.33 鹵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 鹵3.52 days. The total cost of hospitalization was 29466 鹵10494 yuan. In the non-anatomical regular hepatectomy group, the time was 198.11 鹵56.89 min, the intraoperative bleeding was 501.78 鹵288.12 ml, the blood loss was 188.11 鹵78.2 ml, the third day after operation was 211.52 鹵78.26 IU / L, 61.32 鹵15.11 渭 mol / L, and 28.01 鹵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 鹵4.14 days after operation. The total cost of hospitalization was 28466 鹵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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.3

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