目的評(píng)價(jià)精準(zhǔn)肝切除術(shù)在治療肝膽管結(jié)石病中的作用,為肝切除治療肝膽管結(jié)石病提供新的理念。方法回顧性比較分析132例精準(zhǔn)肝切除與52例非規(guī)則性肝切除治療肝膽管結(jié)石病在手術(shù)時(shí)間、術(shù)中出血量、術(shù)后并發(fā)癥、住院時(shí)間、結(jié)石清除率和住院費(fèi)用方面的差異。結(jié)果盡管精準(zhǔn)肝切除組患者手術(shù)時(shí)間〔(364.6±57.8) min〕長(zhǎng)于非規(guī)則性肝切除組〔(292.9±44.7) min〕,P lt;0.001,但其術(shù)中出血量〔(558.3±90.6) ml〕明顯少于非規(guī)則性肝切除組〔(726.7±88.7) ml〕,P lt;0.001,術(shù)后并發(fā)癥明顯更少(11.4%比23.1%,P=0.004 3),結(jié)石清除率更高(89.4%比73.1%,P=0.005 5)。 同樣,精準(zhǔn)肝切除組患者住院時(shí)間〔(22.9±4.4) d〕短于非規(guī)則性肝切除組〔(28.8±3.5) d〕,P lt;0.001,住院費(fèi)用〔(1.8±0.7)×104 元〕也少于非規(guī)則性肝切除組〔(2.1±0.9)×104 元〕,P=0.016 5。結(jié)論精準(zhǔn)肝切除治療肝膽管結(jié)石病優(yōu)于非規(guī)則性肝切除術(shù)。
引用本文: 韋楊年,黃海,莫世發(fā),王克凈,張洪昌,譚新華,李泉. 精準(zhǔn)肝切除在肝膽管結(jié)石病的臨床應(yīng)用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(1): 67-72. doi: 復(fù)制
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2. | 黃志強(qiáng). 肝內(nèi)膽管結(jié)石手術(shù)方法的選擇 [J]. 中國(guó)實(shí)用外科雜志, 1994, 14(3): 136138. |
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5. | 韓殿冰, 董家鴻. 肝切除治療肝膽管結(jié)石病治療效果的Meta分析 [J]. 消化外科, 2006, 5(3): 194196. |
6. | 黃志強(qiáng). 肝內(nèi)膽管結(jié)石外科治療的進(jìn)展 [J]. 中國(guó)實(shí)用外科雜志, 2004, 24(2): 6566. |
7. | 楊連粵, 楊平洲. 肝內(nèi)結(jié)石的肝切除術(shù) [J]. 世界華人消化雜志, 2001, 9(6): 664665. |
8. | Uchiyama K, Onishi H, Tani M, et al. Indication and procedure for treatment of hepatolithiasis [J]. Arch Surg, 2002, 137(2): 149153. |
9. | 韓殿冰, 董家鴻, 郭光金. 對(duì)1 259例肝膽管結(jié)石病臨床病理分型評(píng)價(jià) [J]. 第三軍醫(yī)大學(xué)學(xué)報(bào), 2006, 28(12): 13371338. |
10. | 董家鴻. 肝膽管結(jié)石的臨床病理類型與手術(shù)方式的選擇 [J]. 外科理論與實(shí)踐, 2003, 8(2): 99100. |
11. | 黃潔夫主譯. Blumgart LH, Belghiti J, Jarnagin WR, et al. Surgery of the liver, biliary tract, and pancreas [M]. 4th ed. 北京: 人民衛(wèi)生出版社, 2010: 6768. |
12. | 王學(xué)浩, 陸森. 肝切除技術(shù)的現(xiàn)狀 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(6): 525527. |
13. | 王宏光, 張煊, 董家鴻. 腹腔鏡肝切除技術(shù)的優(yōu)化 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(6): 538542. |
14. | 董家鴻, 何蕾, 張文智, 等. 精準(zhǔn)肝臟外科技術(shù)在復(fù)雜肝臟占位性病變切除中的應(yīng)用 [J]. 中華外科雜志, 2009, 47(21): 16101615. |
15. | Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation [J]. N Engl J Med, 2007, 356(15): 15451559. |
16. | Kumar M, Satapathy S, Monga R, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B [J]. Hepatology, 2007, 45(1): 97101. |
17. | Welsh FK, Ramsden CW, MacLennan K, et al. Increased intestinal permeability and altered mucosal immunity in cholestatic jaundice [J]. Ann Surg, 1998, 227(2): 205212. |
18. | Saito S, Yamanaka J, Miura K, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation [J]. Hepatology, 2005, 41(6): 12971304. |
19. | Lang H, Radtke A, Hindennach M, et al. Impact of virtual tumor resection and computerassisted risk analysis on operation planning and intraoperative strategy in major hepatic resection [J]. Arch Surg, 2005, 140(7): 629638. |
20. | 文天夫, 嚴(yán)律南. 肝切除術(shù)中肝臟血流阻斷技術(shù)的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(4): 299302. |
21. | 王魯, 孫惠川, 欽倫秀, 等. 肝癌解剖性肝切除的初步經(jīng)驗(yàn) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007, 14(1): 3941. |
22. | Eguchi S, Kanematsu T, Arii S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a nonanatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey [J]. Surgery, 2008, 143(4): 469475. |
23. | Descottes B, Lachachi F, Durand Fontanier S, et al. Right hepatectomies without vascular clamping: report of 87 cases [J]. J Hepatobiliary Pancreat Surg, 2003, 10(1): 9094. |
24. | Yamamoto Y, Ikai I, Kume M, et al. New simple techique for hepatic parenchymal resection using a Cavitron Ultrasonic Surgical Aspirator and bipolar cautery equipped with a channel for water dripping [J]. World J Surg, 1999, 23(10): 10321037. |
25. | 許斌, 王建偉, 洪德飛, 等. 規(guī)則性肝切除治療肝內(nèi)膽管結(jié)石的臨床分析 [J]. 中華醫(yī)學(xué)雜志, 2006, 86(24): 17211723. |
26. | 黃志強(qiáng), 黃曉強(qiáng), 宋青. 黃志強(qiáng)膽道外科手術(shù)學(xué) [M]. 第2版. 北京: 人民軍醫(yī)出版社, 2010: 142147. |
- 1. 董家鴻, 黃志強(qiáng). 精準(zhǔn)肝切除-21世紀(jì)肝臟外科新理念 [J]. 中華外科學(xué)雜志, 2009, 47(21): 16011605.
- 2. 黃志強(qiáng). 肝內(nèi)膽管結(jié)石手術(shù)方法的選擇 [J]. 中國(guó)實(shí)用外科雜志, 1994, 14(3): 136138.
- 3. 梁力建, 李紹強(qiáng), 彭寶崗, 等. 肝切除術(shù)治療肝內(nèi)膽管結(jié)石 [J]. 中華肝膽外科雜志, 2006, 12(12): 796800.
- 4. Chen DW, TungPing Poon R, Liu CL, et al. Immediate and longterm outcomes of hepatectomy for hepatolithiasis [J]. Surgery, 2004, 135(4): 386393.
- 5. 韓殿冰, 董家鴻. 肝切除治療肝膽管結(jié)石病治療效果的Meta分析 [J]. 消化外科, 2006, 5(3): 194196.
- 6. 黃志強(qiáng). 肝內(nèi)膽管結(jié)石外科治療的進(jìn)展 [J]. 中國(guó)實(shí)用外科雜志, 2004, 24(2): 6566.
- 7. 楊連粵, 楊平洲. 肝內(nèi)結(jié)石的肝切除術(shù) [J]. 世界華人消化雜志, 2001, 9(6): 664665.
- 8. Uchiyama K, Onishi H, Tani M, et al. Indication and procedure for treatment of hepatolithiasis [J]. Arch Surg, 2002, 137(2): 149153.
- 9. 韓殿冰, 董家鴻, 郭光金. 對(duì)1 259例肝膽管結(jié)石病臨床病理分型評(píng)價(jià) [J]. 第三軍醫(yī)大學(xué)學(xué)報(bào), 2006, 28(12): 13371338.
- 10. 董家鴻. 肝膽管結(jié)石的臨床病理類型與手術(shù)方式的選擇 [J]. 外科理論與實(shí)踐, 2003, 8(2): 99100.
- 11. 黃潔夫主譯. Blumgart LH, Belghiti J, Jarnagin WR, et al. Surgery of the liver, biliary tract, and pancreas [M]. 4th ed. 北京: 人民衛(wèi)生出版社, 2010: 6768.
- 12. 王學(xué)浩, 陸森. 肝切除技術(shù)的現(xiàn)狀 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(6): 525527.
- 13. 王宏光, 張煊, 董家鴻. 腹腔鏡肝切除技術(shù)的優(yōu)化 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(6): 538542.
- 14. 董家鴻, 何蕾, 張文智, 等. 精準(zhǔn)肝臟外科技術(shù)在復(fù)雜肝臟占位性病變切除中的應(yīng)用 [J]. 中華外科雜志, 2009, 47(21): 16101615.
- 15. Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation [J]. N Engl J Med, 2007, 356(15): 15451559.
- 16. Kumar M, Satapathy S, Monga R, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B [J]. Hepatology, 2007, 45(1): 97101.
- 17. Welsh FK, Ramsden CW, MacLennan K, et al. Increased intestinal permeability and altered mucosal immunity in cholestatic jaundice [J]. Ann Surg, 1998, 227(2): 205212.
- 18. Saito S, Yamanaka J, Miura K, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation [J]. Hepatology, 2005, 41(6): 12971304.
- 19. Lang H, Radtke A, Hindennach M, et al. Impact of virtual tumor resection and computerassisted risk analysis on operation planning and intraoperative strategy in major hepatic resection [J]. Arch Surg, 2005, 140(7): 629638.
- 20. 文天夫, 嚴(yán)律南. 肝切除術(shù)中肝臟血流阻斷技術(shù)的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(4): 299302.
- 21. 王魯, 孫惠川, 欽倫秀, 等. 肝癌解剖性肝切除的初步經(jīng)驗(yàn) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007, 14(1): 3941.
- 22. Eguchi S, Kanematsu T, Arii S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a nonanatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey [J]. Surgery, 2008, 143(4): 469475.
- 23. Descottes B, Lachachi F, Durand Fontanier S, et al. Right hepatectomies without vascular clamping: report of 87 cases [J]. J Hepatobiliary Pancreat Surg, 2003, 10(1): 9094.
- 24. Yamamoto Y, Ikai I, Kume M, et al. New simple techique for hepatic parenchymal resection using a Cavitron Ultrasonic Surgical Aspirator and bipolar cautery equipped with a channel for water dripping [J]. World J Surg, 1999, 23(10): 10321037.
- 25. 許斌, 王建偉, 洪德飛, 等. 規(guī)則性肝切除治療肝內(nèi)膽管結(jié)石的臨床分析 [J]. 中華醫(yī)學(xué)雜志, 2006, 86(24): 17211723.
- 26. 黃志強(qiáng), 黃曉強(qiáng), 宋青. 黃志強(qiáng)膽道外科手術(shù)學(xué) [M]. 第2版. 北京: 人民軍醫(yī)出版社, 2010: 142147.