目的探讨与评价三种治疗肝胆管结石的手术指征及优劣性。方法总结2000-2005年703例肝胆管结石患者的临床资料,根据手术方式的不同分为传统开腹组、腹腔镜胆囊切除术+胆总管探查(laparoscopic exploration of common bile duct,LECBD)组、内窥镜括约肌切开术(endoscopic sphincterotomy,EST)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)组,对其手术效果及并发症进行分析。结果全组无胆管损伤,腹腔镜胆囊切除术+胆总管探查+T管引流术(laparoscopic exploration of common bile duct+T-tube drainage,LECBD-TD)/肝叶切除(laparoscopic hepatectomy,LH)的比例逐年分别为0,0.8%,6.1%,16.8%,31.3%,49.2%。胆漏发生率传统开腹组为3.3%,LECBD-TD/LH组为7.4%,胆漏除1例需急诊手术外其余均行引流管引流2-6 d治愈。结论肝胆管结石的治疗模式正在迅速地发生改变,特别是LECBD-TD/LH的比例在逐年升高。我们认为,在传统开腹手术作为保障的前提下,腹腔镜下胆囊切除+胆总管探查取石+肝叶切除、T管引流术可能是治疗肝胆管结石的最佳选择。
Objective To study the effect of liver resection for spontaneous rupture of primary hepatocellulal carcinoma (PHCC). Methods The clinical data of 12 patients with ruptured PHCC treated by liver resection in Xiangya Hospital since 1970 were analyzed retrospectively. Results There were 10 males and 2 females with mean age of 42 (ranged 22–65) years in this series. Of the 12 patients, 11 underwent emergent hepatectomy and one 2-stage hepatectomy, including left segmental liver resection in 6 patients, left median lobectomy in 1, left hemihepatectomy in 1, partial right hepatectomy in 2, and tumor resection in 2. There was no operative death in 11 patients with liver function in grade A of Child-Paugh classification, but 1 patient with grade B liver function died of liver failure after operation. The operative mortality was 8.3%. In 11 survived patients, the postoperative median survival time was 16.5 months. The 1?, 3?, 5-year survival rate was 72.7%, 18.2%, 9.1% respectively; among them one patient has been alive free of the tumor for 25 years and 9 months. Conclusion Liver resection is the best treatment for ruptured PHCC when possible, which can result in long survival time. Key words liver resection - spontaneous ruptare - primary hepatocellular carcinoma
