肝部分切除联合胆肠吻合术治疗肝内胆管结石患者疗效及其结石残留影响因素分析研究*

doi:10.3969/j.issn.1672-5069.2025.04.038

摘要/Abstract

摘要： 目的分析肝部分切除联合胆肠吻合术治疗肝内胆管结石(IHBDS)患者术后结石残留或复发的影响因素。方法 2019年1月～2022年1月我院诊治的50例IHBDS患者,均接受肝部分切除联合胆肠吻合术治疗,常规随访1年。采用ELISA法检测血清C-反应蛋白(CRP)和白细胞介素-6(IL-6),应用多因素Logistic回归分析影响术后结石残留或复发的危险因素。结果术后随访1年,经影像学检查发现50例IHBDS患者残留结石或复发率为20.0%; 结石残留组基线双侧结石、胆总管直径≥15 mm和存在胆道狭窄占比分别为60.0%、60.0%和80.0%,均显著大于无结石残留或复发组的20.0%、20.0%和35.0%,差异有统计学意义(P<0.05);术前,结石残留组白细胞计数、血清CRP、GGT和IL-6水平分别为(7.9±0.9)×10⁹/L、(52.7±4.6)mg/L、(252.7±27.4)U/L和(92.5±14.3)μg/L,均显著高于无结石残留组【分别为(4.6±0.8)×10⁹/L、(25.6±3.0)mg/L、(143.5±26.0)U/L和(65.3±15.2)μg/L,P<0.05】;多因素Logistic回归分析显示,双侧结石、胆总管直径≥15 mm和存在胆道狭窄均是影响术后结石残留或复发的独立危险因素(OR=3.536、OR=3.695、OR=3.404,P<0.05)。结论手术治疗IHBDS存在结石难以清除干净,术后出现结石残留或复发的问题。如何针对高危人群,采取预防措施以减少结石残留或复发还需要进一步研究。

关键词: 肝内胆管结石, 肝部分切除术, 胆肠吻合术, 结石残留/复发, 影响因素

Abstract: Objective The aim of this study was to investigate influencing factors on postoperative stone residual and recurrence in patients with intrahepatic bile duct stones (IHBDS) after partial hepatectomy (ph) and cholangioenterostomy. Methods 50 patients with IHBDS were encountered in our hospital between January 2019 and January 2022, all underwent PH and choledochojejunostomy and were followed-up for one year. Serum C-reactive protein (CRP) and interleukin- 6 (IL-6) levels were detected by ELISA. Multivariate Logistic regression analysis was applied to predict impacting factors of stone residual or recurrence. Results By end of one-year follow-up, stoneresidual was found by imaging in 10 cases (20.0%) among our 50 patients with IHBDS; at baseline, percentages of bilateral lobe bile stone, common bile duct diameter ≥15 mm and biliary stricture in patients with residual stone or recurrence were 60.0%, 60.0% and 80.0%, all much higher than 20.0%, 20.0% and 35.0% (P<0.05) in patients without; at presentation, white blood cell count, serum CRP, GGT and IL-6 levels in patients with stone residual were (7.9±0.9)×10⁹/L, (52.7±4.6)mg/L, (252.7±27.4)U/L and (92.5±14.3)μg/L, all significantly higher than [(4.6±0.8)×10⁹/L, (25.6±3.0)mg/L, (143.5±26.0)U/L and (65.3±15.2)μg/L, respectively, P<0.05] in patients without; multivariate Logistic regression analysis showed that bilateral lobe bile stone, common bile duct diameter ≥15 mm and biliary stricture were all the independent risk factors for stone residual or recurrence(OR=3.536, OR=3.695,OR=3.404, respectively, P<0.05). Conclusion The main problem after PH and cholangioenterostomy in patients with IHBDS is stone residual or recurrence, and how to tackle it still need further clinical investigation.

Key words: Intrahepatic bile duct stones, Partial hepatectomy, Cholangioenterostomy, Residual stone, Recurrence, Influencing factors

王浩瑜, 石党辉, 毛宇锋. 肝部分切除联合胆肠吻合术治疗肝内胆管结石患者疗效及其结石残留影响因素分析研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 629-632.

Wang Haoyu, Shi Danghui, Mao Yufeng. Influencing factors on postoperative stone residual and recurrence in patients with intrahepatic bile duct stones after partial hepatectomy and cholangioenterostomy[J]. Journal of Practical Hepatology, 2025, 28(4): 629-632.

参考文献

[1] Kimura K, Kudo K, Kurihara T, etal. Rendezvous technique using double balloon endoscope for removal of multiple intrahepatic bile duct stones in hepaticojejunostomy after living donor liver transplant: A case report. Transplant Proc, 2019, 51(2): 579-584.
[2] 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.
[3] 郑四鸣, 朱杰, 周新华, 等. 腹腔镜尾状叶肝切除术治疗肝内胆管结石的手术入路和难点探讨. 浙江医学, 2018, 40(24): 2685-2687, 后插2.
[4] Ogura T, Kawai J, Nishiguchi K, et al. Transluminal intrahepatic bile duct stone removal using a novel spiral basket catheter via the endoscopic ultrasound-guided hepaticogastrostomy route (with video). Dig Endosc, 2022, 34(1): 234-237.
[5] Li EL, Yuan RF, Liao WJ, et al. Intrahepatic bile duct exploration lithotomy is a useful adjunctive hepatectomy method for bilateral primary hepatolithiasis: an eight-year experience at a single centre. BMC Surg, 2019, 19(1): 16.
[6] 中华医学会外科学分会胆道外科学组.肝内胆管结石病诊断治疗指南. 中华消化外科杂志, 2007, 6(2): 156-161.
[7] Singh P, Garg HK, Hota JK, et al. Type Va duplication of the common bile duct with type IIIa intrahepatic bile duct anatomy: A rare combination of dual biliary ductal anomaly with difficulty to extract common bileduct stone. J Clin Exp Hepatol, 2022, 12(1): 225-229.
[8] Nakagawa Y, Uchida H, Hinoki A, et al. Laparoscopic bile duct plasty for hilar bile duct stenosis (HBDS) in patients with congenital biliary dilatation: Diagnosis of HBDS by preoperative MRCP and laparoscopic strategy to relieve HBDS. J Hepatobiliary Pancreat Sci, 2023, 30(4): 473-481.
[9] 谢功勋, 史凤霞, 李艳春, 等. 肝内胆管结石及其相关的隐匿性胆管细胞癌的临床病理学特征分析. 中华病理学杂志, 2021, 50(4): 388-390.
[10] Huang L, Lai J, Liao C, et al. Classification of left-side hepatolithiasis for laparoscopic middle hepatic vein-guided anatomical hemihepatectomy combined with transhepatic duct lithotomy. Surg Endosc, 2023, 37(7): 5737-5751.
[11] Campbell WL, Ferris JV, Holbert BL, et al. Biliary tract carcinoma complicating primary sclerosing cholangitis: evaluation with CT, cholangiography, US, and MR imaging. Radiology, 1998, 207(1):41-50.
[12] Liao C, Wang D, Huang L, et al. A new strategy of laparoscopic anatomical hemihepatectomyguided by the middle hepatic vein combined with transhepatic duct lithotomy for complex hemihepatolithiasis: A propensity score matching study. Surgery, 2021, 170(1): 18-29.
[13] 段昌虎, 刘晓晨, 段建峰. 肝部分切除联合胆肠吻合术治疗IHBDS患者疗效比较研究. 实用肝脏病杂志, 2022, 25(1): 112-115.
[14] Mandai K, Inoue T, Uno K. Direct peroral cholangioscopy with narrow band imaging via endoscopic ultrasound-guided hepaticogastrostomy route in malignant choledochojejunostomy anastomotic stricture. Dig Endosc, 2021, 33(7): 144-145.
[15] Tatsuguchi T, Takahashi H, Akita H, et al. Short-and long-term outcomes of choledochojejunostomy during pancreaticoduodenectomy and total pancreatectomy: interrupted suture versus continuous suture. Langenbecks Arch Surg, 2018, 403(8): 959-966.
[16] Bekki Y, Marti J, Toshima T, et al. A comparative study of portal vein embolization versus radiation lobectomy with yttrium-90 micropheres in preparation for liver resection for initially unresectable hepatocellular carcinoma. Surgery, 2021, 169(5): 1044-1051.
[17] Zeng X, Yang P, Wang W. Biliary tract exploration through a common bile duct incision or left hepatic duct stump in laparoscopic left hemihepatectomy for left side hepatolithiasis: which is better?A single-center retrospective case-control study. Medicine (Baltimore), 2018, 97(46): 13080.
[18] 林益坤, 谢朗, 符剑鸣, 等. 肝部分切除联合胆肠吻合术治疗IHBDS患者临床疗效及术后结石复发危险因素分析. 实用肝脏病杂志, 2022, 25(4): 591-594.
[19] Wang X, Wang X, Sun H, et al. Endoscopic papillary large balloon dilation reduces further recurrence in patients with recurrent common bile duct stones: A randomized controlled trial. Am J Gastroenterol, 2022, 117(5): 740-747.
[20] Wang Y, Huang Y, Shi C, et al. Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones. Surg Endosc, 2022, 36(7): 4869-4877.

肝部分切除联合胆肠吻合术治疗肝内胆管结石患者疗效及其结石残留影响因素分析研究^*

Influencing factors on postoperative stone residual and recurrence in patients with intrahepatic bile duct stones after partial hepatectomy and cholangioenterostomy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	李晓静, 黄丽, 莫波, 沈才飞. 影响泼尼松治疗自身免疫性肝炎患者完全应答的多因素分析^*[J]. 实用肝脏病杂志, 2025, 28(4): 565-568.
[2]	党学娟, 谢晓艳, 唐萍, 李敏. 一电力企业男性职工脂肪肝检出情况及影响因素分析研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 474-476.
[3]	钱花, 杨忠祥, 石荔. 核苷(酸)类似物经治的慢性乙型肝炎患者发生低病毒血症影响因素分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 186-189.
[4]	李娟, 程豪, 杨华. 右美托咪定复合丙泊酚麻醉精准肝切除术治疗肝内胆管结石患者麻醉效果分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 298-301.
[5]	武倩, 齐少霞, 李东, 周翼, 付征, 闫诺. 腹腔镜肝叶切除术治疗肝内胆管结石患者肋缘下腹横筋膜阻滞预先镇痛效果研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 302-305.
[6]	刘斐, 姚杰, 张丽骞, 乔志飞, 高乃坤, 王磊, 刘春艳, 李福龙. 32例脓毒症相关性肝损伤患者临床特征及其影响因素分析^*[J]. 实用肝脏病杂志, 2025, 28(1): 76-79.
[7]	叶鹏, 杨本场, 茅明. 恩替卡韦治疗代偿期乙型肝炎肝硬化初治患者远期组织学改善研究^*[J]. 实用肝脏病杂志, 2025, 28(1): 96-99.
[8]	廖余红, 资瑜, 罗剑平. 腹腔镜肝切除术治疗肝内胆管结石患者硬膜外自控镇痛效果研究[J]. 实用肝脏病杂志, 2025, 28(1): 148-151.
[9]	杨爽, 高学松, 段雪飞. 难治性原发性胆汁性胆管炎研究进展^*[J]. 实用肝脏病杂志, 2025, 28(1): 156-159.
[10]	丘仲琼, 林建辉, 翁钘钘, 陈丽霞, 刘海钰. 影响慢加急性乙型肝炎肝衰竭并发医院获得性肺炎患者预后危险因素分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 878-881.
[11]	董旭, 秦阳华, 廖威, 许明晓, 葛玲玲, 李成忠. 乙型肝炎肝硬化和慢加急性肝衰竭患者并发感染影响因素与预后分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 891-894.
[12]	韩洋, 张莉莉, 王雨峰, 贾倩倩. 全身麻醉联合前锯肌平面阻滞和腹直肌后鞘阻滞处置外科手术治疗的肝内胆管结石患者镇痛效果研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 943-946.
[13]	冯梁, 林静, 高敏, 雷宇. 肝内胆管结石患者接受腹腔镜下肝叶切除术竖脊肌平面阻滞与腹横肌平面阻滞镇痛效果对比研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 789-792.
[14]	张天祺, 王敏, 杨娜, 朱怀军. 应用替加环素治疗重症感染患者DILI发生及其影响因素分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 214-217.
[15]	包天舒, 杜野牧, 姚善文, 冯鹤云. 三维适形放疗治疗原发性肝癌患者疗效及发生放射性肝损伤影响因素分析^*[J]. 实用肝脏病杂志, 2024, 27(1): 105-108.