以胆管炎控制量化指标抉择肝胆管结石肝切除的安全性和临床疗效分析

目的 探讨量化的胆管炎控制指标抉择合并胆管炎的肝胆管结石施行肝切除术的安全性和临床疗效。方法 回顾性分析2015年1月至2019年12月江油市人民医院107例肝胆管结石患者行肝切除术的临床资料。经规范治疗达到胆管炎控制的量化指标后，所有合并胆管炎的患者才行肝切除术。依据有无合并急性胆管炎及胆管炎的程度分为无胆管炎组（n=33）、轻度胆管炎组（n=56）、中重度胆管炎组（n=18）。比较三组患者围手术期的一般资料、手术相关指标和术后指标。结果 三组男女比例、年龄、结石分布、手术方式和肝切除范围比较，差异无统计学意义（P＞0.05）。三组手术持续时间（F=0.081）、术中出血量（F=0.920）、术后住院时间（F=0.131）、术后结石残留率（χ2 =0.400）以及术后并发症发生率（χ2 =1.933）比较，差异均无统计学意义（P＞0.05）。中重度胆管炎组术中肝门阻断比率明显高于轻度胆管炎组和无胆管炎组，差异有统计学意义61.11%（11/18）vs 19.64%（11/56）vs 18.19%（6/33）；χ2 =13.699，P＜0.01]；中重度胆管炎组术中肝门阻断时间明显高于轻度胆管炎组和无胆管炎组，差异有统计学意义（30.00±7.75）min vs（32.09 ±10.59）min vs（46.36±11.20）min，F=7.110，P＜0.01）。结论 经规范治疗达到胆管炎控制的量化指标后，合并急性胆管炎的肝胆管结石患者择期行肝切除是安全有效的；但对合并中重度胆管炎的肝胆管结石患者需加强术前出血评估和术中出血控制。

Safety and clinical efficacy of hepatectomy for hepatolithiasis complicated with cholangitis under the quantitative control for cholangitis

Objective To investigate the safety and clinical efficacy of hepatectomy for hepatolithiasis complicated with cholangitis under the quantitative control for cholangitis. Methods Clinical data of 107 hepatolithiasis patients who underwent hepatectomy at the Jiangyou People’s Hospital from Jan. 2015 to Dec. 2019 were retrospectively analyzed. Patients underwent hepatectomy after the quantitative index was obtained for cholangitis control. Patients were divided into non-cholangitis group (n=33), mild cholangitis group (n=56) and moderate/severe cholangitis group (n=18). The general perioperative data, operative indicators and postoperative indicators were compared among the three groups. Results There were no statistically significant differences in clinicopathological features among the 3 groups, including gender, age, stone distribution, surgical methods, and scope of hepatectomy (P>0.05). There were no statistically significant differences among the 3 groups in terms of operation duration (F=0.081), intraoperative blood loss (F=0.920), postoperative hospitalization time (F=0.131), stone residue (χ2 =0.400) or postoperative complications (χ2 =1.933) (all P>0.05). The rate of intraoperative portal occlusion in the moderate/severe cholangitis group was significantly higher than that in the non-cholangitis group and mild cholangitis group 61.11% (11/18) vs 19.64% (11/56) vs 18.19% (6/33), χ2 =13.699, P<0.01]. The duration of portal occlusion in the moderate/severe cholangitis group was significantly longer than that in the mild cholangitis group and the non-cholangitis group (30.00±7.75)min vs (32.09±10.59)min vs (46.36± 11.20)min, F=7.110, P<0.01]. Conclusion It is safe and effective for hepatolithiasis patients complicated with acute cholangitis to receive hepatectomy when the quantitative index is obtained for cholangitis control. However, preoperative bleeding evaluation and intraoperative bleeding control should be strengthened for patients complicated with moderate/severe cholangitis.