规则性肝切除并胆管镜在肝内胆管结石治疗中的应用研究

Application study of regular hepatectomy with choledochoscope in treatment of intrahepatic bile duct stones

目的:研究规则性肝切除并胆管镜治疗肝内胆管结石(intrahepatic bile duct stones,IBDS)的临床疗效;方法:选择我院收治的复杂性IBDS患者76例,随机分为实验组(n=38)与对照组(n=38),实验组行规则性肝切除并胆管镜术,对照组行多肝叶切除术。观察两组肝叶切除情况;术前1d及术后7d总胆红素(TBIL)、白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、凝血酶原时间(APTT)、术后并发症、复发及临床疗效等指标。结果:实验组左半肝切除、左外叶切除、右半肝切除、右后叶切除、左外叶及右后叶切除率与对照组均无统计学差异(均P>0.05)。实验组术后7d TBIL、ALB、ALT、AST、APTT与对照组均无统计学差异(均P>0.05)。实验组治疗优良率(97.37%)显著高于对照组(76.32%),术后并发症发病率(15.79%)显著低于对照组(44.74%),实验组结石残留率(5.26%)显著低于对照组(23.68%),组间比较均有统计学差异(均P<0.05);结论:规则性肝切除并胆管镜术治疗IBDS优良率高,肝功能指标稳定,结石残余率及术后并发症发病率低,值得应用于临床。

Objective： To study the clinical effect of regular hepatectomy with choledochoscope in treatment of intrahepatic bile duct stones （IBDS） ; Methods： A total of 76 patients with complex IBDS treated in our hospital from August 2014 to July 2015 were selected and divided into experimental group （n=38） and control group （n= 38） according to random number table, and baseline information of two groups have no statistical significance （P〉0.05）. Experimental group received regular hepatectomy with choledochoscope and control group received multiple hepatolobectomy. Hepatolobectomy as well as TBII. （total bilirubin）, ALB （albumin）, ALT （alanine aminotransferase）, AST （aspartate aminotransferase）, APTT （activated partial thromboplastin time）, postoperative complications, recurrence, clinical effect and other indexes of two groups 1 d before operation and 7 d after operation were observed; Results： Left hemihepatectomy, left lateral lobectomy, right hemihepatectomy, right posterior lobectomy as well as left lateral and right posterior lobectomy rates of experimental group have no statistical difference compared with control group （P〉0.05）. TBIL, ALB, ALT, AST and APTT of experimental group 7 d after operation have no statistical difference compared with control group （P〉0.05）. Excellent and good rate of treatment of experi mental group （97.37 %） was significantly higher than that of control group （76.32 %）, incidence of postoperative complica- tions （15. 79;//oo） was significantly lower than that of control group （44. 74%）, stone residue rate of experimental group （5.26%）was significantly lower than that of control group （23.68%）, and comparison between groups showed statistical significance （P〈0.05） ：COonelusions： Regular hepatectomy with choledochoscope treatment of IBDS has higher rate of excellence, more stable liver function indexes as well as lower rate of stone residue and lower incidence of postoperative complications, as a result, it＇s worth for application in clinical practice.