肝侧叶肝切除术治疗肝胆管结石合并胆管狭窄患者近期疗效研究*

目的 探讨肝侧叶肝切除术治疗肝胆管结石合并胆管狭窄患者的疗效。方法 2015年1月～2020年1月我院收治的肝胆管结石合并胆管狭窄患者72例,其中38例采取肝侧叶切除术治疗(观察组),另34例接受非肝侧叶切除术治疗(对照组),随访1年。结果 观察组手术时间、术中出血量和住院时间分别为(177.4±20.7)min、(220.6±22.5)ml和(7.1±1.5)d,与对照组【分别为(185.6±25.3)min、(226.2±23.7)ml和(7.5±2.0)d】比,差异无统计学意义(P>0.05);在术后7 d,观察组血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶和碱性磷酸酶水平分别为(35.5±4.2)U/L、(52.4±6.9)U/L和(61.5±6.2)U/L,均显著低于对照组【分别为(50.6±5.3)U/L、(79.8±7.2)U/L和(87.6±7.3)U/L,P<0.05】;观察组结石清除率为100.0%,对照组为97.1%(P>0.05);术后,观察组出现切口感染、化脓性胆管炎、膈下脓肿和胆漏等并发症发生率为7.9%,显著低于对照组的26.5%(P<0.05);在随访期间,观察组结石残留率、结石复发率和再手术率分别为0.0%、2.6%和2.6%,均显著低于对照组(分别为14.7%、20.6%和20.6%,P<0.05)。结论 采取肝侧叶肝切除术治疗肝胆管结石合并胆管狭窄患者近期疗效好,术后并发症发生率、结石残留率、结石复发率和再手术率较低,值得临床进一步验证。

Short-term efficacy of lateral lobe hepatectomy in treatment of patients with hepatolithiasis and biliary stricture

Objective The aim of this study was to investigate the short-term efficacy of lateral lobe hepatectomy in treatment of patients with hepatolithiasis and biliary stricture.Methods 72 patients with hepatolithiasis and biliary stricture were enrolled in our hospital between January 2015 and January 2020,and 38 patients in the observation group received lateral lobe hepatectomy,and 34 in the control group underwent conventional surgery.All patients were followed-up for 12 months.Results The operation time,intraoperative blood loss and post-operational hospitalization stay in the observation were(177.4±20.7)min,(220.6±22.5)ml and(7.1±1.5)d,not significantly different compared to(185.6±25.3)min,(226.2±23.7)ml and(7.5±2.0)d,P>0.05]in the control group;at the end of seven days after operation,serum ALT,AST and ALP levels in the observation were(35.5±4.2)U/L,(52.4±6.9)U/L and(61.5±6.2)U/L,all significantly lower than(50.6±5.3)U/L,(79.8±7.2)U/L and(87.6±7.3)U/L,respectively,P<0.05]in the control;the stone clearance rate in the observation group was 100.0%,not significantly different compared to 97.1%(P>0.05)in the control;post-operationally,the complications,such as infection of incisional wound,Acute obstructive suppurative cholangitis,subphrenic abscess and bile leakage in the observation was 7.9%,significantly lower than 26.5%(P<0.05)in control;during followed-up period,the incidence of stone residual rate,stone recurrence rate and the need for re-surgery in the observation group were 0.0%,2.6%and 2.6%,all significantly lower than 14.7%,20.6%and 20.6%,respectively,in the control group(P<0.05).Conclusion The short-term efficacy of lateral lobe hepatectomy in treatment of patients with hepatolithiasis and biliary stricture in good,with lower incidence of postoperative complications,lower stone residual and stone recurrence,which warrants further clinical verification.