肝部分切除术联合术中胆道镜治疗肝内胆管结石的临床疗效探讨

Study on Clinical Curative Effect of Partial Hepatectomy and Intraoperative Choledochoscope in Treatment of Calculus of Intrahepatic Duct

目的探讨肝部分切除术联合术中胆道镜治疗肝内胆管结石的临床疗效。方法方便选取2015年2月—2016年2月在该院外科治疗的86例肝内胆管结石患者随机分为两组,对照组43例采用胆管切开取石术联合胆道镜治疗,观察组43例采用肝部分切除术联合术中胆道镜治疗,比较两组患者的手术效果、残石率及复发率、并发症发生率。结果观察组手术优良率为97.67%,显著高于对照组的79.07%,差异有统计学意义(P<0.05);观察组结石残留率为9.30%,复发率为6.98%,而对照组结石残留率为25.58%,复发率为27.91%,观察组明显低于对照组,差异有统计学意义(P<0.05);观察组切口感染、肺部感染、胸腔积液、膈下感染等并发症发生率为9.30%与对照组的11.63%相比,差异无统计学意义(P>0.05)。结论肝部分切除术联合术中胆道镜治疗肝内胆管结石手术效果显著,能明显减少结石残留,并减少术后复发,提高手术效果,且并发症发生率低,安全性更高,具有积极的临床意义。

Objective To discuss the clinical curative effect of partial hepatectomy and intraoperative choledochoscope in treatment of calculus of intrahepatic duct. Methods Convenient selection 86 cases of patients with calculus of intrahepatic duct treated in the department of surgery in our hospital from February 2015 to February 2016 were randomly divided into two groups with 43 cases in each, the control group were treated with bile duct incision for removal of calculi and choledochoscope, while the observation group were treated with partial hepatectomy and intraoperative choledochoscope, and the operation effect, residual rate, recurrence rate and incidence rate of complications were compared between the two groups.Results The operation excellent and good rate in the observation group was obviously higher than that in the control group(97.67% vs 79.07%), and the difference was statistically significant(P<0.05), and the stone residual rate and recurrence in the observation group were obviously lower than those in the control group(9.30%, 6.98% vs 25.58%, 27.91%), and the differences were statistically significant(P<0.05), and there was no obvious difference in the incidence rate of complications such as incision infection, lung infection, chest effusion and subphrenic infection between the observation group and the control group(9.30% vs 11.63%)(P>0.05). Conclusion The effect of partial hepatectomy and intraoperative choledochoscope in treatment of calculus of intrahepatic duct is obvious, which can obviously reduce the stone residual, reduce the postoperative recurrence and improve the operation effect with low incidence rate of complications and high safety, and it is of positive clinical significance.