肝叶切除配合胆道镜探查胆总管一期缝合在治疗肝内外胆管结石中的临床疗效研究

The clinical effect of hepatic lobectomy combined with choledochoscopy in the primary suture of common bile duct in the treatment of intrahepatic and intrahepatic bile duct stones

目的:探讨肝叶切除配合胆道镜探查胆总管一期缝合在治疗肝内外胆管结石中的临床疗效。方法:选取2016年2月至2018年12月手术治疗的98例肝内外胆管结石患者为研究对象,按照随机数字分组法分为观察组(n=49)及对照组(n=49)。观察组患者给予规则肝叶、胆囊切除结合胆总管切开胆道镜探查取石并一期缝合,对照组采用胆囊切除、胆总管切开、胆道镜探查取石及T管引流术,记录两组患者围手术期结石残留、手术时间、术中出血、胆汁漏及切口感染情况以及排气时间、住院时间和住院费用,两组患者均开展为期1年的随访,定期磁共振胆胰管造影(magnetic resonance cholangiopancreatography,MRCP)复查,明确是否存在胆管狭窄以及结石复发。结果:观察组术后结石残留率2.04%,低于对照组的14.29%(P<0.05);术中出血、手术时间和切口感染发生率两组差异无统计学意义(P>0.05),观察组胆汁漏1例(2.04%),低于对照组4例(8.16%)(P<0.05);两组患者排气时间、住院时间、住院费用方面差异无统计学意义(P>0.05);随访结果显示,观察组胆总管狭窄与对照组比较,差异无统计学意义(P>0.05),观察组结石复发1例(2.04%)显著优于对照组8例(16.33%)(P<0.05)。结论:肝叶切除配合胆道镜探查胆总管一期缝合治疗肝内外胆管结石疗效确切,术后肝内外胆道残石、结石复发率低,值得临床推广使用。

Objective:To investigate the clinical efficacy of lobectomy combined with choledochoscopy in the primary suture of common bile duct in the treatment of intrahepatic and extrahepatic bile duct stones.Methods:From February 2016 to December 2018,98 patients with intrahepatic and extrahepatic bile duct stones who underwent surgical treatment were divided into observation group(n=49)and control group(n=49)according to random number grouping.Patients in the observation group were treated with regular liver and cholecystectomy combined with choledocholithotomy and primary suture.Patients in the control group were treated with cholecystectomy,choledocholithotomy,choledochoscopy and T-tube drainage.The duration of the operation,the time of operation,the time of operation,the bleeding,the bile leakage and the incision infection,the patient's exhaust time,hospital stay and hospitalization expenses were recorded.Patients in both groups were followed up for 1 year,and MRCP was regularly reviewed to determine whether there was bile duct stenosis and stone recurrence.Results:Postoperative residual calculus was found in 1 case(2.04%)in the observation group,which was significantly better than that in 7 cases(14.29%)in the control group(P<0.05).There was no difference in intraoperative hemorrhage,operation time and incidence of incision infection(P>0.05).1 case of bile leakage in the observation group(2.04%)was significantly lower than 4 cases(8.16%)in the control group(P<0.05).There was no significant difference between the two groups in terms of exhaust time,hospitalization time and hospitalization cost(P>0.05).The follow-up results showed that there was no significant difference between the observation group and the control group in common bile duct stenosis(P>0.05).The recurrence of calculi in 1 case(2.04%)in the observation group was significantly better than that in 8 cases(16.33%)in the control group(P<0.05).Conclusion:Hepatic lobectomy combined with choledochoscopy in the primary suture of common bile duct for the treatment of intrahepatic and intrahepatic bile duct calculi is effective,and the postoperative residual stone of intrahepatic and intrahepatic bile duct and stone recurrence rate are low,which is worthy of clinical promotion and use.