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*

doi:10.3969/j.issn.1672-5069.2022.01.028

摘要/Abstract

摘要： 目的观察肝部分切除术联合胆肠吻合术治疗肝内胆管结石患者的疗效。方法 2017年2月～2020年2月我院收治的68例肝内胆管结石患者,其中观察组38例接受肝部分切除术联合胆肠吻合术治疗,对照组30例接受肝部分切除术联合T管引流术,术后随访12个月。采用ELISA法或双抗体夹心免疫发光法检测血清白细胞介素-6(IL-6)和C反应蛋白(CRP)。结果观察组手术时间、术中出血量和住院日分别为(106.7±29.8)min、(261.7±64.2)mL和(15.5±3.5)d,显著长于或多与对照组【分别为(64.3±27.7)min、(190.3±49.0)mL和(10.2±2.3)d, P＜0.05】; 在术后7 d,观察组血清CRP和IL-6水平分别为(38.0±5.9)mg/L和(99.6±10.7)μg/L,显著高于对照组【分别为(25.2±5.1)mg/L和(83.6±9.8)μg/L, P＜0.05】;手术前后,两组血清肝功能指标无显著性差异(P>0.05);随访3个月,术后两组出现切口感染、胆漏、胆道出血和胸腹腔积液等并发症发生率比较,差异无统计学意义(13.2%对13.3%,P＞0.05);术后6周行超声检查,发现观察组结石残留率为5.3%,显著低于对照组的23.3%(P＜0.05),在随访12个月末,观察组结石复发率为13.2%,显著低于对照组的33.3%(P＜0.05)。结论采取肝部分切除术联合胆肠吻合术治疗肝内胆管结石患者可减少结石残留和结石复发,其效果需进一步观察。

关键词: 肝内胆管结石, 肝部分切除术, 胆肠吻合术, 治疗

Abstract: Objective The aim of this study was to observe the clinical efficacy of partial hepatectomy and choledochojejunostomy in treatment of patients with hepatolithiasis. Methods 68 patients with hepatolithiasis were admitted to our hospital between February 2017 and February 2020, and 38 patients in the observation group underwent partial hepatectomy and choledochojejunostomy., and 30 cases in the control underwent partial hepatectomy only. All patients were followed-up for 12 months after surgery. Serum interleukin-6 (IL-6) and C-reactive protein (CRP) were detected by ELISA or by double-antibody sandwich immunoluminescence method. Results The operation time, intraoperative blood loss and hospitalization stay in observation group were(106.7±29.8)min,(261.7±64.2)mL and (15.5±3.5)d, significantly longer or greater than [(64.3±27.7)min,(190.3±49.0)mL and (10.2±2.3)d, respectively, P＜0.05] in the control; seven days after operation, serum CRP and IL-6 levels in the observation group were (38.0±5.9)mg/L and (99.6±10.7)μg/L, significantly higher than [(25.2±5.1)mg/L and (83.6±9.8)μg/L, respectively, P＜0.05] in the control; there were no significant differences respect to serum hepatic function tests before and after operation between the two groups (P>0.05); at the end of three month followed-up, the incidences of incisional infection, bile leak, biliary bleeding and pleural-peritoneal effusion in the two groups were not significantly different (13.2% vs. 13.3%, P＞0.05); the sonography check-up six weeks after surgery showed that the stone residual rate in the observation group was 5.3% (2/38), significantly lower than 23.3% (7/30, P<0.05) in the control, and at the end of 12-month followed-up, the stone recurrence in the observation group was 13.2%, significantly lower than 33.3%(P＜0.05) in the control. Conclusion The application of partial hepatectomy and choledochojejunostomy in the treatment of patients with hepatolithiasis might reduce stone residuals and recurrence, and needs to be further verified.

Key words: Hepatolithiasis, Partial hepatectomy, Choledochojejunostomy, Surgery

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^*[J]. 实用肝脏病杂志, 2022, 25(1): 112-115.

Duan Changhu, Liu Xiaochen, Duan Jianfeng. Clinical observation of partial hepatectomy and choledochojejunostomy in treatment of patients with hepatolithiasis[J]. Journal of Practical Hepatology, 2022, 25(1): 112-115.

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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^*

Clinical observation of partial hepatectomy and choledochojejunostomy in treatment of patients with hepatolithiasis

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