肝部分切除术联合纤维胆道镜治疗肝胆管结石的临床观察

Clinical observation of partial hepatectomy combined with fibrocholedochoscopy in the treatment of hepatolithiasis

目的探讨肝部分切除术联合纤维胆道镜治疗肝胆管结石的效果。方法抽取2021年1月至2022年6月郑州大学第一附属医院收治的肝胆管结石患者132例为研究对象,依据手术方法分为肝切除组与联合组,每组66例。肝切除组患者采取肝部分切除术治疗,联合组患者则采取肝部分切除术联合纤维胆道镜治疗。统计并比较两组患者术后相关临床指标、并发症发生率、结石残留率及复发率。比较两组治疗前后相关生化指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBil)及间接胆红素(DBil)]。结果两组排气时间、排便时间、拔管时间、进食时间、下床时间及住院时间比较差异未见统计学意义(P>0.05)。术后7 d,联合组AST、ALT、GGT、ALP、TBil及DBil水平均低于肝切除组(P均<0.05)。联合组并发症发生率(4.55%,3/66)与肝切除组(7.58%,5/66)比较差异未见统计学意义(P>0.05)。联合组术后结石残留率(1.52%,1/66)及复发率(0.00%,0/66)均低于肝切除组(13.64%,9/66;12.12%,8/66),差异有统计学意义(P<0.05)。结论与肝部分切除术相比,肝部分切除术联合纤维胆道镜有助于肝胆管结石患者的肝功能恢复,能降低结石残留率及复发率。

Objective To investigate the therapeutic effect of partial hepatectomy combined with fibrocholedochoscopy on hepatolithiasis.Methods A total of 132 patients with hepatolithiasis treated in the First Affiliated Hospital of Zhengzhou University from January 2021 to June 2022 were selected as research objects,and they were divided into hepatectomy group and combined group according to the surgery method,with 66 cases in each group.Patients in the hepatectomy group were treated by partial hepatectomy,and patients in the combined group were treated by partial hepatectomy combined with fibrocholedochoscopy.The postoperative clinical indicators,incidence of complications,stone residual rate and recurrence rate were compared between the two groups.The preoperative and postoperative related biochemical indexes,including aspartate aminotransferase(AST),alanine aminotransferase(ALT),γ-glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),total bilirubin(TBil)and direct bilirubin(DBil),were compared between the two groups.Results There was no significant difference in flatus time,defecating time,extubation time,feeding time,out-of-bed activity time and hospital stay between the two groups(P>0.05).The levels of AST,ALT,GGT,ALP,TBil and DBil in the combined group were lower than those in the hepatectomy group(all P<0.05).The incidence of complications in the combined group(4.55%,3/66)was not significantly different from that in the hepatectomy group(7.58%,5/66),P>0.05.The residual stone rate and recurrence rate in the combined group were 1.52%(1/66)and 0.00%(0/66),respectively,lower than the 13.64%(9/66)and 12.12%(8/66)in the hepatectomy group after operation(P<0.05).Conclusions Compared with hepatectomy alone,hepatectomy combined with fibrocholedochoscopy,in the treatment of hepatolithiasis,can restore liver function and reduce the residual stone rate and recurrence rate.