多肝段切除术联合胆道镜取石术在复杂型肝内胆管结石治疗中的作用

Therapeutic effect of the combined treatment of multiple segmental resection and choledochoscope lithotomy on complex intrahepatic biliary calculi

目的：了解多肝段切除术联合胆道镜取石术在复杂型肝内胆管结石治疗中的作用，为该病提供有效的手术治疗方法。方法采用数字表法将213例复杂型肝内胆管结石被随机分为观察组117例和对照组96例，对照组采用多肝段切除术进行治疗，观察组采用多肝段切除术联合胆道镜取石术进行治疗。观察两组术后出现的并发症情况；术后对两组进行随访，并评价手术治疗效果。结果观察组住院时间（10．1±3．4）d，显著短于对照组的（13．7±4．6）d（t ＝6．560，P ＜0．05）。术后3～6周观察组结石残留率7．69％（9／117），低于对照组，差异有统计学意义（χ2＝4．099，P ＜0．05）。两组术后随访时间（11．2±3．9）个月。观察组手术优良率89．74％（105／117），高于对照组（χ2＝9．154，P ＜0．05）。观察组术后并发症发生率18．80％（22／117）低于对照组，差异有统计学意义（χ2＝14．467，P ＜0．05）。结论在复杂型肝内胆管结石的治疗中，多肝段切除术联合胆道镜取石术具有更好的疗效，术后并发症发生率较低，具有较高的临床应用价值。

Objective To learn therapeutic effect of the combined treatment of multiple segmental resection and choledochoscope lithotomy on complex intrahepatic biliary calculi.To provide effective and reliable operation method for the treatment of disease.Methods 213 cases with complex intrahepatic biliary were randomly divided into observation group（117 cases）and control group（96 cases）by random number table method.The control group was treated with multiple segmental resection,the observation group was treated with multiple segmental resection combined choledochoscope lithotomy.The postoperative complications of the two groups were observed,and the patients of the two groups were followed up,and the effect of surgical treatment was evaluated.Results The hospitalization time of the observation group was （10.1 ±3.4）d,which was significantly shorter than （13.7 ±4.6）d of the control group （t =6.560,P 〈0.05）.Postoperative 3 -6 weeks residual stone rate of the observation group was 7.69%（9 /117）, which was lower than that of the control group,the difference was statistically significant （χ2 =4.099,P 〈0.05）.In both two groups,the average duration of follow -up was （11.2 ±3.9）months.In the observation group,the excellent and good rate of surgery 89.74%（105 /117）was higher than the control group （χ2 =9.154,P 〈0.05）.The postoperative complication rate of the observation group 18.80%（22 /117）was lower than that of the control group,the difference was statistically significant （χ2 =14.467,P 〈0.05）.Conclusion In the treatment of complex intrahepatic biliary calculi,the combined treatment of multiple segmental resection and choledochoscope lithotomy has better curative effect and low postoperative complication rate,with good clinical application value.