胆道镜下肝胆管切开取石术和肝部分切除术治疗肝内胆管结石的疗效对比

Effect comparison on hepatic duct incision nephrolithotomy by choledochoscope and partial hepatectomy in the treatment of hepatolithiasis

目的探讨对比肝内胆管结石患者采用肝部分切除术和胆道镜下肝胆管切开取石术治疗效果。方法 80例肝内胆管结石患者,随机分为对照组和治疗组,各40例。对照组采用肝部分切除术治疗,治疗组采用胆道镜下肝胆管切开取石术治疗,观察两组患者并发症情况、手术情况及结石残留情况。结果治疗组术中出血量为(66.75±17.61)ml,下床活动时间为(0.48±0.21)d,手术时间为(123.50±48.75)min,均显著低于对照组的(146.51±25.59)ml、(3.13±0.56)d、(167.31±18.71)min,差异有统计学意义(P<0.05)。治疗组并发症发生率为7.5%,显著低于对照组的25.0%,差异有统计学意义(P<0.05)。治疗组术后复发率及结石残留率均显著低于对照组,差异有统计学意义(P<0.05)。结论肝内胆管结石采用胆道镜下肝胆管切开取石术具有创伤小、并发症少、恢复快等优点,且术后复发率、结石残留率均较低,具有推广价值。

Objective To explore and compare the effect of hepatolithiasis treated with hepatic duct incision nephrolithotomy by choledochoseope and partial hepatectomy. Methods A total of 80 hepatolithiasis patients were randomly divided into control group and treatment group, with 40 cases in each group. The control group received partial hepatectomy for treatment, and the treatment group received hepatic duet incision nephrolithotomy by choledoehoscope for treatment. Observation were made on complications, operation and calculi residual situation in two groups. Results The treatment group had intraoperative bleeding volume as （66.75 ± 17.61） ml, off-bed acitvity time as （0.48 ±0.21） d, operation time as （123.50 ± 48.75） min, which were all obviously lower than （146.51 ±25.59） ml, （3.13 ± 0.56） d and （167.31 ± 1.8.71） min in the control group, and their differences had statistical significance （P〈0.05）. The treatment group had significantly lower incidence of complications as 7.5% than 25.0% in the control group, and the difference had statistical significance （P〈0.05）. The treatment group had obviously lower postoperative recurrence rate and calculi residual rate than those of the control group, and their differences had statistical significance （P〈0.05）. Conclusion For the treatment of hepatolithiasis, hepatic duct incision nephrolithotomy by choledochoscope shows little trauma, less complications and quick recovery, as well as low postoperative recurrence rate and calculi residual rate, and it has the promotion value.