三种手术方式治疗肝内外胆管结石的疗效比较

Clinical Analysis of Partial Liver Resection Combined with Choledochoscope for Intrahepatic and Extrahepatic Bile Duct Stones

目的:比较肝部分切除联合胆道镜探查取石、胆总管切开取石"T"管引流以及胆管空肠Roux-en-Y吻合3种手术方式在治疗肝内外胆管结石中的临床疗效。方法:分析241例肝内外胆管结石患者的临床资料,比较肝部分切除联合胆道镜探查取石(A组)、胆总管切开取石"T"管引流(B组)以及胆管空肠Roux-en-Y吻合(C组)3种术式术后患者的结石残留率、结石复发率、胆管炎发生率以及再次手术率。结果:A组结石残留率(9.5%)低于B组(29.4%)和C组(38.2%),A组结石复发率(8.4%)低于B组(20.2%)和C组(22.2%),A组胆管炎发生率(7.2%)低于B组(19.1%)和C组(37%),A组再次手术率(2.4%)低于B组(13.1%)和C组(11.1%),差异均有统计学意义(P<0.05)。结论:肝部分切除术是治疗肝内外胆管结石有效的手术方式,联合应用胆道镜探查取石,可明显提高远期疗效。

Objective： To discuss and compare clinical efficacy of partial hepatectomy combined with choledochoscope for exploration and stone removal,choledochotomy for stone removal and T tube drainage and Roux-en-Y choledochojejunostomy in treating intra-and extrahepatic biliary duct stones.Methods： A total of 241 cases of patients with intra-and extrahepatic bile duct stones were enrolled in this study and divided into 3 goups： A group（ partial hepatectomy combined with choledochoscope for exploration and stone removal）,B group（ choledochotomy for stone removal and T tube drainage）,C group（ Roux-en-Y choledochojejunostomy）. The clinical data of 3 groups were analyzed retrospectively to compare rate of residual stone,rate stone recurrence,incidence of cholangitis and rate of reoperation. Results： The rate of residual stone in A group（ 9. 5%） was lower than that in B group（ 29. 4%） and C group（ 38. 2%）. The rate of stone recurrence in A group（ 8. 4%） was lower than that in B groups（ 20. 2%） and C group（ 22. 2%）. The incidence of cholangitis in A group（ 7. 2%）was lower than that in B group（ 19. 1%） and C group（ 37%）. The rate of reoperation in A group（ 2. 4%） was lower than that in B group（ 13. 1%） and C group（ 11. 1%）. All the differences were statistically significant（ P 0. 05）. Conclusion： Partial hepatectomy is the most effective surgical procedure to treat the intra-and extrahepatic bile duct stones,whose clinical efficacy can be improved when combined with choledochoscope.