肝部分切除联合胆肠吻合术治疗肝内胆管结石患者临床疗效及术后结石复发危险因素分析*

doi:10.3969/j.issn.1672-5069.2022.04.034

摘要/Abstract

摘要： 目的研究采用肝部分切除联合胆肠吻合术治疗肝内胆管结石患者的临床疗效,分析术后结石复发的相关危险因素。方法 2018年1月～2021年1月我院收治的62例肝内胆管结石患者,其中29例对照组患者接受肝部分切除术治疗,33例观察组患者接受肝部分切除联合胆肠吻合术治疗,术后随访所有患者1年。使用全自动生化分析仪检测血生化指标,应用Logistic回归分析影响术后结石复发的相关危险因素。结果手术后,两组血清ALT和AST水平下降,低水平黄疸消退;术后两组并发症发生率比较无显著性差异(9.1% 对13.8%,P＞0.05);在术后随访1年,超声检查显示观察组结石复发率为15.2%,显著低于对照组的41.4%(P＜0.05);在62例肝内胆管结石患者中,术后结石复发17例(27.4%);单因素分析结果显示,复发与未复发患者结石残留、胆道狭窄和手术方法存在显著性差异(P＜0.05);多因素Logistic回归分析显示,结石残留[OR(95%CI)为3.5(1.3～9.6)]和胆道狭窄[OR(95%CI)为2.7(1.1～6.6)]是影响肝内胆管结石患者术后结石复发的独立危险因素,而手术方法[OR(95%CI)为0.4(0.1～0.9)]为其保护因素(P＜0.05)。结论采用肝部分切除联合胆肠吻合术治疗肝内胆管结石患者可显著降低术后结石复发率,值得进一步研究。

关键词: 肝内胆管结石, 肝部分切除术, 胆肠吻合术, 治疗, 复发

Abstract: Objective The aim of this study was to investigate the clinical efficacy of partial hepatectomy and choledochojejunostomy combination in the treatment of patients with hepatolithiasis, and to analyze the risk factors for postoperative stone recurrence. Methods 62 patients with hepatolithiasis were enrolled in our hospital between January 2018 and January 2021, and among them, 29 patients in the control were treated with partial hepatectomy and 33 patients in the observation were treated with partial hepatectomy and choledochojejunostomy combination. All patients were followed-up for 1 year after operation. The risk factors for postoperative recurrence was analyzed by multivariate Logistic regression. Results After the operation in both group, serum ALT and AST levels decreased greatly, and total serum bilirubin levels turned back to normal; there was no significant differences as respect to the post-operational complications(9.1% vs. 13.8%, P＞0.05); at the end of one-year follow-up, the ultrasonography showed the stone recurrence rate in the observation was 15.2%, significantly lower than 41.4%(P＜0.05) in the control; out of the 62 patients with hepatolithiasis, 17 cases (27.4%)had intrahepatic stone recurrence after operation; the univariate Logistic regression analysis showed that the residual stone, biliary stricture and the operation itself were different between patients with and without stone recurrence, and the multivariate Logistic regression analysis demonstrated that residual stone [OR(95%CI):3.5(1.3-9.6)] and biliary stricture [OR(95%CI):2.7(1.1-6.6)] were the risk factors for post-operational stone recurrence, while the partial hepatectomy and choledochojejunostomy [OR (95%CI) :0.3 (0.1-0.9)] was the good choice for patients with hepatolithiasis. Conclusion The partial hepatectomy and choledochojejunostomy combination in the treatment of patients with hepatolithiasis could reduce the risk of postoperative stone recurrence, which warrants further clinical investigation.

Key words: Hepatolithiasis, Partial hepatectomy, Choledochojejunostomy, Therapy, Stone recurrence

林益坤, 谢朗, 符剑鸣, 崔春晖. 肝部分切除联合胆肠吻合术治疗肝内胆管结石患者临床疗效及术后结石复发危险因素分析^*[J]. 实用肝脏病杂志, 2022, 25(4): 591-594.

Lin Yikun, Xie Lang, Fu Jianming, et al. Clinical efficacy of partial hepatectomy and choledochojejunostomy combination in the treatment of patients with hepatolithiasis and risk factors for postoperative recurrence[J]. Journal of Practical Hepatology, 2022, 25(4): 591-594.

参考文献

[1] Zhang Z, Li Y, Li K, et al. Value of multidisciplinary team (MDT) in minimally invasive treatment of complex intrahepatic bile duct stones. Biosci Trends, 2021, 15(3):161-170.
[2] Zhang WL, Fang ZP, Shi BY, et al. Low-pressure pulse flushing choledochoscopy combined with neodymium laser lithotripsy for the treatment of intrahepatic bile duct stones. Hepatob Pancreat Dis Int, 2021, 20(4):383-386.
[3] Wang H, Ou Y, Ou J, et al. Contrast of therapeutic effects between DBD incision and LLHD stump in biliary tract exploration of LLs for hepatolithiasis. Surg Endosc, 2020,34(2):915-919.
[4] Nam NH, Taura K, Kanai M, et al. Unexpected metastasis of intraductal papillary neoplasm of the bile duct without an invasive component to the brain and lungs: A case report. World J Gastroenterol, 2020,26(3):366-374.
[5] 何少武,吴波,徐洁,等.解剖性肝切除联合术中胆道镜治疗复杂肝内胆管结石的疗效分析.中华肝胆外科杂志,2019,25(9):681-684.
[6] Miyazaki T, Shinkawa H, Takemura S, et al. Precancerous lesions and liver atrophy as risk factors for hepatolithiasis - related death after liver resection for hepatolithiasis. Asian Pac J Cancer Prev,2020,21(12):3647-3654.
[7] Chen G, Tian F, Zhao X, et al. Perihilar hepatectomy for hepatolithiasis with compressed hilar bile duct induced by perihilar hyperplasia of liver. J Invest Surg, 2020,33(6):505-513.
[8] 中国医师协会外科医师分会微创外科医师专业委员会.腹腔镜治疗肝胆管结石病的专家共识(2013年版).中华消化外科杂志,2013,12(1):1-5.
[9] Ogura T, Nishioka N, Ueno S, et al. Transluminal stone removal from right intrahepatic bile duct using novel basket catheter. Endoscopy, 2020, 52(7):E223-E224.
[10] 伍婵璐,姜瑜,肖燕.胆管结石合并胆道细菌感染患者胆汁病原菌及其预后影响因素.中华医院感染学杂志,2021,31(2):238-243.
[11] 吴金术.肝胆管盆式内引流术治疗肝胆管结石的手术方法.中华普通外科杂志,2001,16(6):378.
[12] 彭创,黄甫,孙增鹏,等. 内吻合在肝内胆管结石合并胆管口狭窄治疗中的应用.中华普通外科杂志,2020,35(6):471-175.
[13] 段昌虎,刘晓晨,段建峰. 肝部分切除联合胆肠吻合术治疗肝内胆管结石患者疗效比较研究.实用肝脏病杂志,2022,25(1):112-115.
[14] Sugimoto S, Murabayashi T, Ichikawa A, et al. Laparotomy-assisted direct cholangioscopy for bile duct stone removal via an incision of the jejunum. Case Rep Gastroenterol, 2021, 15(2):674-679.
[15] Wang L, Peng Y, Xu Z, et al. Laparoscopic hepatectomy combined with choledochoscopy in the treatment of intrahepatic and common bile duct stones. HPB, 2019, 21(1):S274-S276.
[16] Watanabe ALC, de Freitas ACT, Stadnik L, et al. Hepatectomy and intrahepatic hepaticocutaneous jejunostomy for bilateral primary hepatolithiasis: Case report. Int J Surg Case Rep, 2020,72(1):69-71.
[17] Liu B, Ma J, Li S, et al. Percutaneous transhepatic papillary balloon dilation versus endoscopic retrograde cholangiopancreatography for common bile duct stones: A multicenter prospective study. Radiology, 2021, 300(2):470-478.
[18] Murabayashi T, Kanno Y, Koshita S, et al. Long-term outcomes of endoscopic papillary large-balloon dilation for common bile duct stones. Intern Med, 2020, 59(7):891-899.
[19] Deng F, Zhou M, Liu PP, et al. Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study. World J Clin Cases, 2019, 7(9):1028-1037.
[20] Li S, Su B, Chen P, et al. Risk factors for recurrence of common bile duct stones after endoscopic biliary sphincterotomy. J Int Med Res, 2018, 46(7):2595-2605.

肝部分切除联合胆肠吻合术治疗肝内胆管结石患者临床疗效及术后结石复发危险因素分析^*

Clinical efficacy of partial hepatectomy and choledochojejunostomy combination in the treatment of patients with hepatolithiasis and risk factors for postoperative recurrence

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