肝胆管结石手术方式与疗效分析

Analysis of approaches for surgical treatment of hepatolithiasis and their efficacy

目的 分析肝胆管结石手术治疗的方式与疗效的关系。方法 随访 16年间因肝胆管结石接受手术治疗的病人 4 18例 ,其中胆镜联合肝切除 36例并与同期其他术式比较其临床疗效。结果 4 5 0例中获随访 4 18例 (92 9% ) ,手术至随访时间 6个月至 16年 5个月 (平均 6年 8个月 ) ,术中未用胆镜取石与使用胆镜取石组的残石率、胆管炎复发率、结石复发率、再手术率分别为 37 6 %和8 6 % (χ2 =4 1 4 ,P <0 0 1)、16 9%和 1 3% (χ2 =2 3 6 ,P <0 0 1)、10 2 %和 3 9% (χ2 =5 1,P <0 0 5 )、2 3 7%和 5 9% (χ2 =2 1 4 ,P <0 0 1) ;无切肝组与切肝组的残石率、胆管炎复发率、结石复发率、再手术率分别为 30 3%和 8 1% (χ2 =13 2 8,P <0 0 1)、12 9%和 1 6 % (χ2 =6 77,P <0 0 1)、9 0 %和 1 6 % (χ2 =4 5 5 ,P <0 0 5 )、2 0 2 %和 0 (χ2 =15 15 ,P <0 0 1)。结论 术中使用胆镜联合肝切除、胆肠吻合可明显提高肝胆管结石病人的疗效。

Objective To investigate the relationship between approaches and their efficacy for surgical treatment of hepatolithiasis. Methods In the past 16 years, 418 patients with hepatolithiasis receiving surgical treatment in our hospital were followed up. Thirty six of the 418 patients who received the choledochoscopy in combination with hepatectomy were compared with other patients undergoing other surgical treatments in therapeutic efficacy. Results All patients were followed up for an average of 6 years and 8 months. The residual calculus rate was 37 6% and 8 6% (χ 2=41 4, P<0 01), the recurring rate of cholangitis 16 9% and 1 3% (χ 2=23 6, P<0 01), recurring rate of calculus 10 2% and 3 9% (χ 2=5 1, P<0 05) and the re operating rate 23 7% and 5 9% (χ 2=21 4, P<0 01) in the patients undergoing choledochoscopy and those without performance of choledochoscopy, respectively. The residual calculus rate was 30 3% and 8 1% (χ 2=13 28, P<0 01), recurring rate of cholangitits 12 9% and 1 6% (χ 2=6 77, P<0 01), recurring rate of the calculus 9 0% and 1 6% (χ 2=4 55, P<0 05) and re operating rate 20 2% and 0 in the non hepatectomy group and hepatectomy group, respectively. Conclusions Use of choledochoscopy in combination with hepatectomy and choledocho ileostomy during the operation can effectively promote the therapeutic efficacy of surgical treatment for hepatolithiaisis.