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 of Choledochoscopic Hepatobiliary Lithotomy and Partial Hepatectomy in Intrahepatic Stone

目的探讨肝内胆管结石采取两种手术治疗的临床疗效。方法方便选取2017年8月—2018年8月该院接收的66例肝胆管结石患者,将入选者随机分为对照组(组内33例,采取肝部分切除术治疗)与观察组(组内33例,采取胆道镜下肝胆管切开取石术治疗),观察手术相关指标,对患者随访6个月,观察复发率。结果观察组患者术中出血量(50.75±8.52)mL较对照组的(152.11±12.34)mL明显要少,差异有统计学意义(t=-38.829,P<0.05),手术时间(114.35±9.76)min、下床活动时间(1.45±0.41)d、住院时间(6.75±2.14)d均分别较对照组的(140.66±8.22)min、(3.35±1.02)d、(9.05±2.45)d明显要短,差异有统计学意义(t=-11.844、-9.929、-4.062,P<0.05);观察组患者术后并发症发生率9.1%相比于对照组的24.2%明显要低,差异有统计学意义(χ^2=8.215,P<0.05);观察组复发率3.0%及结石残留率0.0%相比于对照组的15.2%、15.2%均明显要低,差异有统计学意义(χ^2=8.997、16.450,P<0.05);观察组术后1、3 d的CRP分别为(20.55±1.22)mg/L、(13.22±1.45)mg/L,均分别低于对照组的(30.45±1.47)mg/L、(23.41±1.47)mg/L(t=-29.771、-25.350,P<0.05);术后1、3 d的血糖分别为(5.92±0.33)mmol/L、(5.52±0.32)mmol/L,均分别低于对照组的(7.25±0.14)mmol/L、(6.12±1.04)mmol/L,差异有统计学意义(t=-21.314、-3.168,P<0.05)。结论肝内胆管结石患者采取胆道镜下肝胆管切开取石术,结石残留少,手术创伤小,术后复发率,应激反应小,术后恢复快,并发症少,值得于临床广泛推广。

Objective To discuss the clinical efficacy of two surgical methods in intrahepatic stone.Methods 66 intrahepatic stone patients from August 2017 to August 2018 were convenient selected and randomLy assigned to two groups,33 cases in each group.The control group was treated with partial hepatectomy;the observation group was treated with choledochoscopic hepatobiliary lithotomy.The operation indicators and recurrence rate after 6m of follow-up visit were recorded.Results The intraoperative blood loss(50.75±8.52)mL in the observation group was significantly less than that in the control group(152.11±12.34)mL,the difference was statistically significant(t=-38.829,P<0.05),the operation time(114.35±9.76)min,and the time of getting out of bed.(1.45±0.41)d,hospitalization time(6.75±2.14)d were significantly shorter than the control group(140.66±8.22)min,(3.35±1.02)d,(9.05±2.45)d,the difference was statistically significant(t=-11.844,-9.929,-4.602,P<0.05);the postoperative complication rate of the observation group was 9.1%lower than that of the control group(24.2%),the difference was statistically significant(χ^2=8.215,P<0.05);the recurrence rate of the observation group was 3.0%and The residual rate of stones was 0.0%compared with 15.2%and 15.2%of the control group,the difference was statistically significant(χ^2=8.997,16.450,P<0.05).The CRP of the observation group at 1 d and 3 d was(20.55±1.22)mg/L,(13.22±1.45)mg/L,were lower than the control group(30.45±1.47)mg/L,(23.41±1.47)mg/L(t=-29.771,-25.350,P<0.05);The blood glucose at 1 d and 3 d after operation was(5.92±0.33)mmol/L and(5.52±0.32)mmol/L,respectively,which were lower than that of the control group(7.25±0.14)mmol/L,(6.12±1.04)mmol/L,the difference was statistically significant(t=-21.314,-3.168,P<0.05).Conclusion The choledochoscopic hepatobiliary lithotomy can reduce the stone residual rate,clinical trauma,recurrence rate,stress response and complication rate,and promote patient’s fast recovery.It shall be widely applied in clinical practice.