精准肝切除术与非规则性肝切除术治疗肝内胆管结石患者临床疗效对比

Comparative analysis of clinical efficacy of precise hepatectomy and irregular hepatectomy in the treatment of intrahepatic bile duct stones

目的对比精准肝切除术与非规则性肝切除术治疗肝内胆管结石患者的临床疗效,旨在为临床治疗提供相应的循证依据。方法选取本院在2014年10月~2016年8月收治的96例肝内胆管结石患者。将患者按照不同治疗方式分为观察组与对照组,每组各48例。观察组患者采用精准肝切除术治疗,对照组患者采用非规则性肝切除术治疗。比较两组患者结石清除率、手术时间、术中出血量、住院时间、住院费用以及术后并发症的影响,同时观察患者术后肝功能指标[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、总胆汁酸(TBA)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)]变化情况。结果两组住院时间、治疗费用、术中出血量比较,观察组均少于对照组(P<0.05);手术治疗时间观察组长于对照组(P<0.05);治疗后,观察组康复优所占比例高于对照组(P<0.05),良所占比例低于对照组(P<0.05);两组患者差所占比例比较无差异(P>0.05),观察组临床治疗疗效优于对照组(P<0.05);观察组患者结石清除率高于对照组(χ~2=11.090,P=0.001);治疗前两组患者ALT、TBIL、TBA、ALP、GGT比较无差异(P>0.05),治疗后两组患者ALT、TBIL、TBA、ALP、GGT均有改善,但是观察组患者改善程度优于对照组(P<0.05);观察组患者并发症发生率低于对照组(P<0.05)。结论精准肝切除术与非规则性肝切除治疗肝内胆管结石,除了手术时间长于非规则性肝切除术外,在临床疗效、肝功能改善、结石清除率以及降低并发症等方面均优于对照组,并能减少术后住院时间以及住院费用,可在临床推广应用。

Objective To analyze the clinical efficacy of precise hepatectomy and irregular hepatectomy in the treat- ment of intrahepatic bile duct stones and provide the theoretical basis for clinical treatment. Methods 96 patients with in- trahepatic bile duct stones were selected as subjects admitted to our hospital from October 2014 to August 2016. Patients were divided into observation group and control group （48 cases in each group） according to different treatment methods. The patients in the observation group were treated with precise hepatectomy, and the patients in the control group were treated with irregular hepatectomy. The stone clearance rate, operation time, intraoperative blood loss, hospital stays, hospitalization expenses, postoperative complications and liver function indexes （ALT, TBIL, TBA, ALP, GGT） chan- ges of the two groups were observed. Results The hospitalization time, treatment costs, the amount of intraoperative bleeding in the observation group were less than that of the control group （P〈0.05）. The surgical treatment time of ob- servation group was longer than that of the control group （P〈0.05）. The proportion of Kangfuyou in the observation group （75.00%） was significantly higher than that in the control group （47.92%）（P〈0.05）. The proportion of benign （20.83 %） was significantly lower than that of control group （45.83 %） （P〈0.05）. No difference was detected between the two groups （P〈0.05）. The clinical curative effect of the observation group was better than that of the control group （P〈0.05）. The removal rate of stones in the observation group was [93. 75% （45/48）] and the control group was [66.67% （32/48）]. The removal rate of stones in the observation group was significantly higher than that in the control group （X2=11.090, P=0.001）. ALT, TBIL, TBA, ALP, GGT were not significantly different between the two groups before treatment （P〈0.05）. ALT, TBIL, TBA, ALP and GGT were improved in the two groups after treat ment, but the improvement of the observation group was significantly better than that of the control group （P〈0.05）. The incidence of complications in the observation group （12.50%） was significantly lower than that in the control group （31.25%） （P〈0.05）. Conclusion Intrahepatic choledocholithiasis is treated with precise hepatectomy and irregular liv- er resection. The operation time is longer than the irregular liver resection. The clinical treatment, liver function im- provement, stone clearance rate and the complications and other aspects of the observation group are better than that of the control group. It can reduce the length of hospital stay and hospitalization costs.