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題名 | 肝葉切除術以治療左肝內結石症 |
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作者 | 李金德; 柯成國; 沈柏青; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 21:3 1988.05[民77.05] |
頁次 | 頁282-286 |
分類號 | 416.246 |
關鍵詞 | 肝葉切除術; 左肝內結石症; |
語文 | 中文(Chinese) |
中文摘要 | 肝內結石症需因其結石位置及肝管形態而使用不同的手術術式,以達到移除結石及改善胆汁鬱流的目的。在諸多的手術術式中,肝葉切除術可以得到最好的成績及預防結石再發。我們最近五年,共短發33例以肝葉切除治療肝內結石的病例;其中21例是在術中超音波引導下進行肝葉切除,這些病例在切除後僅有1例(48%)有殘留結石,與未使用術中超音波的12例,有6例(50%)的殘留結石相較(p <0.001)顯示術中超音波的使用確可減少術後殘留結石。肝葉切除術後由於殘留結石較少,術後胆道鏡使用次數也大多減少,33例肝葉切除例,共使用2.30±2.51次,而非肝葉切除的129例,則為10.1±6.7次,統計學上呈有意義差里(p<0.001),在治療成績方面,肝葉切除群33例中,1例治療失敗,須再手術,治療率為97%,而非肝葉切除群的49例例中,5例治療失敗,治療率為88.1%;且長期追踪調查結果,肝葉切除群沒有結石再發,而非肝葉切除群則有10例(27%)結石再發。 |
英文摘要 | Thirty-three patients of left intrahepatic stone, treated with left hepatectomy, were reported. It represented a ra te of 16.3% for hepatectomy as a treatment of intrahepatic stone in a total of 202 patients in recent 5 years in this hospital. Among the 33 patients, 13 were men and 20 women, with ages ranging from 26 to 58 years, with a mean of 41.8±8.6 years. Thirty-two patients received left lateral segmentectomy and one a left hepatic lobectomy. Intraoperative ultrasonography (IOU) was undertaken during hepatectomy to delineate the location of hepatolithiasis before hepatectomy and to scan for residual stones in the remaining lobe after resection. Of those using IOU during hepatectomy, only one of 21 patients (4.8%) had residual stones postoperatively, conversely, 6 of 12 patients (50%) had residual stones when IOU was not used. The difference is significant, p<0.001. The sessions of postoperative choledochoscopy were 2 .03±2.51 sessions in 33 patients for the hepatectomy group, and 10.l±6.7 sessions in 129 patients for the non-hepatectomy group. This difference is also significant, p<0.001. Long term follow-up was undertaken for patients in both groups. The cure rate for the hepatectomy group was 97.1% and 88.1% for the non-hepatectomy group. No recurrent stones were found in the hepatectomy group, but there was a 27% recurrence rate in the non-hepatectomy group. This led us to conclude that left hepatectomy for left intrahepatic stone is a definitive treatment, with favorable results. |
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