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*

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。

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

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.