肝内胆管结石手术治疗62例临床研究

Retrospective study on surgical treatment of intrahepatic bile duct stones

目的:分析肝内胆管结石外科治疗62例患者资料,探索肝内胆管结石最佳手术治疗方案。方法:收集62例肝内胆管结石患者手术治疗资料。依据手术方式分为腹腔镜肝部分切除术(A组,23例),肝部分切除术(B组,19例),胆总管探查取石术(C组,20例)。收集并分析手术时间、术中出血、术后肝功能、并发症(腹腔积液、切口感染、肺部感染、切口疝、肝脓肿、胆漏)发生率、残石率、术后心电监护时间、术后腹腔引流时间、术后肠道排气时间等资料。应用χ^(2)检验、ANOVA检验、Kruskal-Wallis H检验进行统计分析。结果:3组数据手术时间中位数分别为444.0(325.0,574.0)、320.0(250.0,348.0)、222.0(166.3,272.5),C组指标低于A组(P<0.01)且C组指标低于B组(P<0.05);3组数据的出血量中位数分别200.0(100.0,400.0)、400.0(200.0,700.0)、100.0(56.5,200.0),术中出血A组指标低于B组(P<0.05),B组指标高于C组(P<0.01);3组数据术后7 d白蛋白的中位数分别为33.6(30.7,36.1)、30.1(27.4,30.8)、31.0(28.6,33.8),白蛋白A组指标高于B组(P<0.05)。3组患者术后腹腔引流管拔除时间中位数为6.0(6.0,8.0)、8.0(7.0,9.0)、5.0(6.5,7.8),术后腹腔引流时间A组指标低于B组(P<0.01),C组指标低于B组(P<0.01);3组数据组内并发症发生率分别为4.35%、26.32%、10.00%,3组数据差异无统计学意义(P>0.05);残石率分别为21.7%、47.4%、60%,A组指标低于B组(χ^(2)=3.076,P<0.125)且A组指标低于C组(χ^(2)=0.655,P<0.125)。术后除白蛋白以外的其他肝功能指标、术后并发症发生率、术后心电监护时间、术后肠道排气时间比较均无统计学意义。结论:腹腔镜肝部分切除术出血量最少,术后7 d白蛋白恢复快,残石率更低,值得推广。胆总管探查取石术出血量最少,适合不耐受肝部分切除术的患者。

Objective Analyze the data of 62 patients with intrahepatic bile duct stones undergoing surgical treatment,and explore the optimal surgical treatment plan for intrahepatic bile duct stones.Methods Collect surgical treatment data of 62 patients with intrahepatic bile duct stones.According to the surgical methods,it is divided into laparoscopic partial hepatectomy(Group A,n=23 cases),partial hepatectomy(Group B,n=19 cases),and choledocholithotomy(Group C,n=20 cases).Collect and analyze data on surgical time,intraoperative bleeding,postoperative liver function,incidence of complications(abdominal fluid accumulation,incision infection,lung infection,incision hernia,liver abscess,bile leakage),residual stone rate,postoperative electrocardiogram monitoring time,postoperative abdominal drainage time,and postoperative intestinal exhaust time.Statistical analysis was conducted using Chi-square test,ANOVA test,and Kruskal Wallis H-test.Results The median surgical time for the three groups of data was 444.0(325.0,574.0),320.0(250.0,348.0),and 222.0(166.3,272.5),respectively.The indicators in Group C were lower than those in Group A(P<0.01),and the indicators in Group C were lower than those in Group B(P<0.05);The median bleeding volume of the three groups of data was 200.0(100.0,400.0),400.0(200.0,700.0),and 100.0(56.5,200.0),respectively.The intraoperative bleeding indicators in Group A were lower than those in Group B(P<0.05),while those in Group B were higher than those in Group C(P<0.01);The median values of albumin at 7 days after surgery were 33.6(30.7,36.1),30.1(27.35,30.8),and 31.0(28.6,33.8)for the three sets of data,with albumin indicators in Group A were being higher than Group B(P<0.05).The median postoperative time for removal of abdominal drainage tubes in three groups of patients was 6.0(6.0,8.0),8.00(7.0,9.0),and 5.0(6.5,7.8).The postoperative abdominal drainage time in Group A was lower than that in Group B(P<0.01),while in Group C,it was lower than that in Group B(P<0.01);The incidence of complications within the three data groups was 4.35%,26.32%,and 10.00%,respectively,with no statistically significant difference(P>0.05);The residual stone rates were 21.7%,47.4%,and 60%,respectively,and the indicators in Group A were lower than those in Group B(χ^(2)=3.076,P<0.125)and the indicators in Group A are lower than those in Group C(χ^(2)=0.655,P<0.125).There was no statistically significant difference in postoperative liver function indicators,incidence of postoperative complications,postoperative electrocardiogram monitoring time,and postoperative intestinal exhaust time,except for albumin.Conclusion Laparoscopic partial hepatectomy has the least amount of bleeding,faster recovery of albumin 7 days after surgery,and lower residual stone rate,which is worth promoting.The common bile duct exploration and stone removal surgery has the least amount of bleeding and is suitable for patients who do not tolerate partial hepatectomy.