不同肝切除术治疗肝左外叶胆管结石的效果及术后肝内胆管结石复发的影响因素分析

Analysis of effect of different hepatectomy on left lateral lobe bile duct stones of liver and influencing factors of postoperative recurrence of hepatolithiasis

目的分析不同肝切除术治疗肝左外叶胆管结石的效果及术后肝内胆管结石复发的影响因素,为临床医生合理选择手术方式提供参考。方法将120例肝左外叶胆管结石患者根据肝切除术的不同分为肝左外叶切除术+胆道镜探查术组(肝左外叶切除组,n=70)和左半肝切除术+胆道镜探查术组(左半肝切除组,n=50)。比较两组患者的手术时间、术中出血量、术后住院天数及术后1周谷丙转氨酶(ALT)、总胆红素、白蛋白水平。比较两组患者的术后胆漏、出血、感染及结石复发情况。采用单因素及多因素Logistic回归分析探讨术后肝内胆管结石复发的影响因素。结果左半肝切除组的手术时间、术后住院天数长于肝左外叶切除组,术中出血量多于肝左外叶切除组,差异具有统计学意义(P<0.05);两组术后1周ALT、总胆红素、白蛋白水平比较,差异无统计学意义(P>0.05)。两组术后胆漏、出血、感染发生率比较,差异无统计学意义(P>0.05);肝左外叶切除组术后结石复发率高于左半肝切除组,差异具有统计学意义(P<0.05)。单因素分析结果显示,复发及未复发患者的手术方式、生活环境、井水水源、胆肠吻合手术占比及年龄比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,在控制年龄、生活环境、井水水源、胆肠吻合手术的混杂效应情况下,手术方式是术后肝内胆管结石复发的影响因素(P<0.05)。结论对于肝左外叶胆管结石患者,在综合分析适应证和可行性的情况下,行左半肝切除术+胆道镜探查术虽在手术时间、术中出血量、术后住院天数方面不及肝左外叶切除术+胆道镜探查术,但其可显著降低术后肝内胆管结石复发率,减少再手术次数。

Objective To analyze the effect of different hepatectomy on left lateral lobe bile duct stones of liver and influencing factors of postoperative recurrence of hepatolithiasis,so as to provide reference for clinicians to select reasonable surgical methods.Methods According to different hepatectomy,120 patients with left lateral lobe bile duct stones of liver were divided into hepatic left lateral lobectomy+choledochoscopy exploration group(hepatic left lateral lobectomy group,n=70)and left hepatectomy+choledochoscopy exploration group(left hepatectomy group,n=50).The operation time,intraoperative blood loss,postoperative hospital stay and alanine aminotransferase(ALT),total bilirubin and albumin levels at 1 week after operation were compared between the two groups.The postoperative bile leakage,bleeding,infection and stone recurrence were compared between the two groups.The univariate and multivariate Logistic regression analysis were used to investigate the influencing factors of postoperative recurrence of hepatolithiasis.Results The operation time and postoperative hospital stay in the left hepatectomy group were longer than those in the hepatic left lateral lobectomy group,the intraoperative blood loss was more than that in the hepatic left lateral lobectomy group,and the differences were statistically significant(P<0.05);there was no significant differences in ALT,total bilirubin and albumin levels at 1 week after operation between the two groups(P>0.05).There were no significant differences in the incidences of postoperative bile leakage,bleeding and infection between the two groups(P>0.05);the recurrence rate of stones in the hepatic left lateral lobectomy group was higher than that in the left hepatectomy group,and the difference was statistically significant(P<0.05).The univariate analysis results showed that there were significant differences in the proportions of surgical method,living environment,well water source,biliary-enteric anastomosis and age between patients with recurrence and without recurrence(P<0.05).The multivariate Logistic regression analysis results showed that,under the condition of controlling the mixed effects of age,living environment,well water source and biliary-enteric anastomosis,the surgical method was the influencing factor for postoperative recurrence of hepatolithiasis(P<0.05).Conclusion For patients with left lateral lobe bile duct stones of liver,in the case of comprehensive analysis of indications and feasibility,although left hepatectomy+choledochoscopy exploration is inferior to hepatic left lateral lobectomy+choledochoscopy exploration in terms of operation time,intraoperative blood loss and postoperative hospital stay,it can significantly reduce the recurrence rate of postoperative hepatolithiasis and reduce the number of reoperation.