左肝内胆管结石切除左肝外叶辅以胆道镜的临床干预探析-论文.pdf

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1、-116-ClinicalJournalofChineseMedicine2014Vol.(6)No.24DOI:10.3969/j.issn.1674-7860.2014.24.050左肝内胆管结石切除左肝外叶辅以胆道镜的临床干预探析Analysisontheclinicalinterventionofcholedochoscopeinlefthepaticloberesectionofintrahepaticbiliarycalculi孙强虎（江苏省沭阳县中医院，江苏沭阳，223600）中图分类

2、号：R657.4文献标识码：A文章编号：1674-7860（2014）24-0116-03证型：IDG【摘要】目的：探析切除左肝外叶辅以胆道镜取石治疗左肝内胆管结石的效果。方法：临床组实施肝左外叶切除辅以胆道镜取石术，参照组实施左半肝切除辅以胆总管切开取石术。统计两组手术基本情况，术后并发症情况，近期疗效及结石残留情况。结果：临床组其手术时长及失血量均显著低于参照组（P＜0.05）。临床组1人肝功能受损，2人胆瘘，3人肺部感染，4人切口感染或愈合差，合计并发症发生率19.40%；参照组2人肝功能受损

3、，3人胆瘘，7人肺部感染，13人切口感染或愈合差，合计并发症发生率37.31%。临床组并发症几率显著低于参照组（P＜0.05）。临床组手术优良率91.04%，参照组为86.57%。临床组结石残余率5.97%，参照组为0。两组手术优良率和结石残余率比照无显著差异（P＞0.05）。结论：左肝内胆管结石实施切除肝左外叶辅以胆道镜取石术可在保障疗效的同时显著降低手术创伤、降低术后并发症。【关键词】胆管结石；肝切除；胆道镜【Abstract】Objective:Toinvestigatetheeffectof

4、choledochoscopeinthetreatmentoflefthepaticloberesectionofintrahepaticbiliarycalculi.Methods:Hepaticleftlaterallobectomywithcholedochofiberscopywasgiventotheclinicgroup,whilelefthemihepatectomywithcholedocholithotomywasgiventothecontrolgroup.Thebasiccon

5、dition,complication,recenteffectandothersituationswereanalyzed.Results:Theclinicdurationandbloodlossofthecontrolgroupwassignificantlylowerthanthatofthecontrolgroup（P＜0.05）.Intheclinicgroup,1casegotimpairedliverfunction,2caseswithbiliaryfistula,3caseswi

6、thpulmonaryinfection,4caseswithinfectionorhealingdifferenceincisionandtheincidencerateofcomplicationwas19.40%;inthecontrolgroup,2casesgotimpairedliverfunction,3caseswithbiliaryfistula,7caseswithpulmonaryinfection,13caseswithinfectionorhealingdifference

7、incisionandtheincidencerateofcomplicationwas37.31%.Theincidencerateofcomplicationwassignificantlylowerthanthatofthecontrolgroup（P＜0.05）.Theexcellentrateoftheclinicgroupwas91.04%andthecontrolgroup86.57%.Therateofresidualstonesintheclinicgroupwas5.97%,oi

8、nthecontrolgroup.Twogroupsofoperationtheexcellentandgoodrateandtherateofresidualstoneshadnosignificantdifference（P＞0.05）.Conclusion:Choledochoscopeinthetreatmentoflefthepaticloberesectionofintrahepaticbiliarycalculicanreducethedamageand