肝内胆管结石手术治疗62例临床研究  

Retrospective study on surgical treatment of intrahepatic bile duct stones

作　　者：徐文东 陈维佳 孙早喜[1] Xu Wendong;Chen Weijia;Sun Zaoxi(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Hainan Medical University,Haikou 570216,China)

机构地区：[1]海南医学院第一附属医院肝胆外科,海口570102 [2]海南医学院第二附属医院肝胆外科,海口570216

出　　处：《中华实验外科杂志》2023年第6期1117-1120,共4页Chinese Journal of Experimental Surgery

基　　金：海南省重点研发项目(ZDYF2016116)。

摘　　要：目的:分析肝内胆管结石外科治疗62例患者资料,探索肝内胆管结石最佳手术治疗方案。方法:收集62例肝内胆管结石患者手术治疗资料。依据手术方式分为腹腔镜肝部分切除术(A组,23例),肝部分切除术(B组,19例),胆总管探查取石术(C组,20例)。收集并分析手术时间、术中出血、术后肝功能、并发症(腹腔积液、切口感染、肺部感染、切口疝、肝脓肿、胆漏)发生率、残石率、术后心电监护时间、术后腹腔引流时间、术后肠道排气时间等资料。应用χ^(2)检验、ANOVA检验、Kruskal-Wallis H检验进行统计分析。结果:3组数据手术时间中位数分别为444.0(325.0,574.0)、320.0(250.0,348.0)、222.0(166.3,272.5),C组指标低于A组(P<0.01)且C组指标低于B组(P<0.05);3组数据的出血量中位数分别200.0(100.0,400.0)、400.0(200.0,700.0)、100.0(56.5,200.0),术中出血A组指标低于B组(P<0.05),B组指标高于C组(P<0.01);3组数据术后7 d白蛋白的中位数分别为33.6(30.7,36.1)、30.1(27.4,30.8)、31.0(28.6,33.8),白蛋白A组指标高于B组(P<0.05)。3组患者术后腹腔引流管拔除时间中位数为6.0(6.0,8.0)、8.0(7.0,9.0)、5.0(6.5,7.8),术后腹腔引流时间A组指标低于B组(P<0.01),C组指标低于B组(P<0.01);3组数据组内并发症发生率分别为4.35%、26.32%、10.00%,3组数据差异无统计学意义(P>0.05);残石率分别为21.7%、47.4%、60%,A组指标低于B组(χ^(2)=3.076,P<0.125)且A组指标低于C组(χ^(2)=0.655,P<0.125)。术后除白蛋白以外的其他肝功能指标、术后并发症发生率、术后心电监护时间、术后肠道排气时间比较均无统计学意义。结论:腹腔镜肝部分切除术出血量最少,术后7 d白蛋白恢复快,残石率更低,值得推广。胆总管探查取石术出血量最少,适合不耐受肝部分切除术的患者。Objective Analyze the data of 62 patients with intrahepatic bile duct stones undergoing surgical treatment,and explore the optimal surgical treatment plan for intrahepatic bile duct stones.Methods Collect surgical treatment data of 62 patients with intrahepatic bile duct stones.According to the surgical methods,it is divided into laparoscopic partial hepatectomy(Group A,n=23 cases),partial hepatectomy(Group B,n=19 cases),and choledocholithotomy(Group C,n=20 cases).Collect and analyze data on surgical time,intraoperative bleeding,postoperative liver function,incidence of complications(abdominal fluid accumulation,incision infection,lung infection,incision hernia,liver abscess,bile leakage),residual stone rate,postoperative electrocardiogram monitoring time,postoperative abdominal drainage time,and postoperative intestinal exhaust time.Statistical analysis was conducted using Chi-square test,ANOVA test,and Kruskal Wallis H-test.Results The median surgical time for the three groups of data was 444.0(325.0,574.0),320.0(250.0,348.0),and 222.0(166.3,272.5),respectively.The indicators in Group C were lower than those in Group A(P<0.01),and the indicators in Group C were lower than those in Group B(P<0.05);The median bleeding volume of the three groups of data was 200.0(100.0,400.0),400.0(200.0,700.0),and 100.0(56.5,200.0),respectively.The intraoperative bleeding indicators in Group A were lower than those in Group B(P<0.05),while those in Group B were higher than those in Group C(P<0.01);The median values of albumin at 7 days after surgery were 33.6(30.7,36.1),30.1(27.35,30.8),and 31.0(28.6,33.8)for the three sets of data,with albumin indicators in Group A were being higher than Group B(P<0.05).The median postoperative time for removal of abdominal drainage tubes in three groups of patients was 6.0(6.0,8.0),8.00(7.0,9.0),and 5.0(6.5,7.8).The postoperative abdominal drainage time in Group A was lower than that in Group B(P<0.01),while in Group C,it was lower than that in Group B(P<0.01);The incidence of complications wit

关 键 词：肝内胆管结石 外科治疗 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]