3种术式治疗肝内胆管结石效果及2年随访结果分析

Effects of three kinds of operation in treatment of hepatolithiasis and analysis of two-year follow-up visit results

目的探讨3种不同术式治疗肝内胆管结石效果及2年随访结果。方法以本院收治的120例肝内胆管结石患者为研究对象,其中肝段或肝叶切除+T管引流术治疗50例,作为A组;高位胆管切开取石+T管引流术治疗40例,作为B组;胆肠Roux-Y吻合术治疗30例,作为C组。比较3组临床疗效、围术期并发症、术后结石残余及2年肝内结石及胆管炎复发情况。结果 3组的总有效率有显著差异(P<0.05),其中A组最高为94.00%,其次为B组(85.00%),C组最低(73.33%);A组术后结石残余率为10.00%,显著低于B组和C组(35.00%、33.33%)(P<0.05);A组并发症发生率较高,但与其他两组比较均无统计学差异(P>0.05)。随访2年中,A组肝内结石和胆管炎复发均最低,其次为B组,最高为C组,但组间差异无统计学意义(P>0.05)。结论相比高位胆管切除取石+T管引流术和胆肠Roux-Y吻合术,肝段或肝叶切除+T管引流术治疗肝内胆管结石,术后结石残余率较低,结石及胆管炎复发率也较低,但其并发症较多,因此,临床需根据患者病情及手术适应证选择合理术式。

Objective To explore the effects of three different kinds of operation in the treatment of hepatolithiasis and analyze two-year follow-up visit results. Methods A total of 120 patients with hepatolithiasis admitted to our hospital were selected and divided into three groups. Group A(n=50) was treated with hepatic segment or hepatic lobes resection +T-tube drainage; group B(n=40) was treated with high bile duct lithotomy +T-tube drainage; group C(n =30) was treated with biliointestinal Roux-Y anastomosis. The effects, perioperative complications, postoperative residual stone and recurrence of intrahepatic calculi and angiocholitis in two years among the three groups were compared. Results The overall response rate(ORR) in the three groups showed significant difference(P <0.05); the ORR in group A(94.00%) was the highest, and that in group B(85.00%) was the second and in group C(73.33%) was the lowest; the postoperative residual stone rate in group A was 10.00%, which was significantly lower than that in groups B and C(35.00% and 33.33%, respectively)(P < 0.05); the incidence of complication in group A was high, showing no statistical difference from the other two groups(P > 0.05). During the two-year follow-up visit, the recurrence rate of intrahepatic calculi and angiocholitis in group A was the lowest, and that in group B was the second and in group C was the highest; however, there was no statistical difference among the three groups(P > 0.05). Conclusion The treatment of hepatolithiasis with hepatic segment or hepatic lobes resection +T-tube drainage has lower postoperative residual stone rate, lower recurrence rate of intrahepatic calculi and angiocholitis and more complications than that with high bile duct lithotomy +T-tube drainage and biliointestinal Roux-Y anastomosis. Therefore,appropriate operation should be clinically selected according to the conditions of patients and operative indications.