区域型肝内胆管结石手术方法选择及术后结石残留、复发的危险因素分析

Selection of surgical methods for regional intrahepatic bile duct stones and analysis of risk factors for postoperative stone residual and recurrence

目的:探究临床治疗区域型肝内胆管结石安全且有效的术式,探讨影响患者术后结石残留及复发的主要危险因素,以便为该类结石的临床治疗及预后改善提供参考。方法:选择接受肝组织切开取石术(肝组织切开组,77例)和解剖性肝切除(解剖学组,91例)治疗的区域性肝内胆管结石患者为研究对象。对比两组患者一般手术情况、术后并发症、结石残留和复发情况;分析影响患者术后结石残留及复发的主要危险因素。结果:解剖学组术中出血量和住院时间明显短于肝组织切开组(P<0.01),术后切面感染、胆漏、结石残留和结石复发率均明显低于肝组织切开组(P<0.05)。二元Logistic回归分析显示,术前合并胆道狭窄(OR:2.782,95%CI:0.895~4.251)、结石呈双侧分布(OR:2.309,95%CI:1.527~5.377)及肝组织切开治疗(OR:1.986,95%CI:0.902~12.746)是影响区域型肝内胆管结石术后残留的独立危险因素(P<0.05);术前合并胆道狭窄(OR:8.611,95%CI:6.974~27.483)、结石呈双侧分布(OR:4.315,95%CI:1.527~8.377)、肝组织切开治疗(OR:2.930,95%CI:1.102~7.255)和术后结石残留(OR:6.026,95%CI:1.102~7.255)是影响区域型肝内胆管结石术后复发的独立危险因素(P<0.05)。结论:解剖学肝切除术治疗区域型肝内胆管结石安全且有效,可作为该类胆管结石临床治疗的首选术式。术前合并胆道狭窄、结石呈双侧分布及手术方式选择不当均会增加区域型肝内胆管结石术后残留及复发风险。

Objective:To explore the safe and effective surgical procedures for clinical treatment of regional intrahepatic bile duct stones,and to explore the main risk factors affecting postoperative stone residual and recurrence in patients,so as to provide references for the clinical treatment and prognostic improvement of such type of stones.Methods:Patients with regional intrahepatic bile duct stpones treated by liver tissue incision and lithotripsy(hepatectomy group,77 cases)and anatomical liver resection(anatomy group,91 cases)were selected as research subjects.The general operation conditions,postoperative complications,residual stones and recurrence were compared between two groups.The main risk factors affecting the residual stones and recurrence of the patients were analyzed.Results:Intraoperative blood loss and hospital stay in the anatomy group were significantly shorter than those in the hepatectomy group(P<0.01),and the postoperative cut surface infection,bile leakage,residual stone and stone recurrence rates were significantly lower than those in hepatectomy group(P<0.05).Logistic regression analysis showed that preoperative biliary stricture(OR=2.782,95%CI:0.895-4.251),bilateral distribution of stones(OR=2.309,95%CI:1.527-5.377)and liver tissue incision treatment(OR=1.986,95%CI:0.902-12.746)were independent risk factors affecting the residual postoperative regional intrahepatic bile duct stones(P<0.05).Preoperative biliary stricture(OR=8.611,95%CI:6.974-27.483),bilateral distribution of stones(OR=4.315,95%CI:1.527-8.377),liver tissue incision treatment(OR=2.930,95%CI:1.102-7.255),and postoperative stone residues(OR=6.026,95%CI:1.102-7.255)were independent risk factors for the recurrence of regional intrahepatic bile duct stones(P<0.05).Conclusion:Anatomical hepatectomy is safe and effective for the treatment of regional intrahepatic bile duct stones,and can be the first choice for clinical treatment of this type of bile duct stones.Preoperative biliary strictures,bilateral distribution of stones,and improper selection of surgical methods will increase the risk of residual and recurrence of regional intrahepatic bile duct stones.