胆肠内引流联合T管外引流术治疗肝胆管结石病疗效研究

目的探讨肝胆管结石病实施胆肠内引流联合T管外引流术的临床疗效。方法回顾性分析2014年1月至2018年7月安徽医科大学第一附属医院普外科收治的95例肝胆管结石病行胆肠内引流术病人资料,根据胆道引流的手术方式分为胆肠内引流组(内引流组)和内引流联合T管外引流组(内外引流组),比较两组手术安全性和近远期临床疗效。结果 95例肝胆管结石病人中,胆肠内引流组71例,内外引流组24例,两组术后切口感染、腹腔出血、肝功能不全发生率差异无统计学意义(P>0.05)。内引流组胆漏发生率显著高于内外引流组(21.1%vs. 4.2%,P<0.05),但内引流组结石即时清除率明显高于内外引流组(P<0.05),最终结石取净率两组差异无统计学意义(P>0.05)。结论对于肝胆管结石病术中无法取尽者,实施胆肠内引流联合T管外引流术可有效降低胆漏发生率,提高术后结石取净率,改善生活质量。

Clinical analysis of choledchojejunostomy combined with T tube external drainage in the treatment of hepatolithiasis

Clinical analysis of choledchojejunostomy combined with T tube external drainage in the treatment of hepatolithiasis LIU Lei，LIU Fu-bao，ZHAO Yi-jun，et al. Department of General Surgery, Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Anhui Medical University High-Tech Branch, Hefei 230001，China
Corresponding author：LIU Fu-bao，E-mail：249412043@qq.com
Abstract Objective To investigate the curative effect of choledchojejunostomy combined with T-tube drainage on patients with hepatolithiasis. Methods The clinical data of 95 patients with hepatolithiasis electivly undergoing choledchojejunostomy from January 2014 to July 2018 in the First Affiliated Hospital，Anhui Medical University were retrospectively analyzed. According to the operation methods，the patients were divided into two groups：choledchojejunostomy group and choledchojejunostomy group with T-tube drainage group. The short-term and long-term clinical efficacy of T tube external drainage were analyzed. Results Among 95 cases of hepatolithiasis，71 cases were treated with choledchojejunostomy and 24 cases were treated with choledchojejunostomy combined with T tube drainage. There was no significant difference in incision infection，hemorrhage and hepatic insufficiency between the two groups （P＞0.05）. The incidence of bile leakage in the choledchojejunostomy group was significantly higher than that in the choledchojejunostomy with T tube drainage group （P＜0.05），but the immediate stone clearance rate in the choledchojejunostomy group was significantly higher than that in thecholedchojejunostomy with T tube drainage group （P＜0.05）.There was no significant difference in the final stone removal rate between the two groups（P＞0.05）. Conclusion Choledochojejunostomy plus T-tube drainage can effectively reduce the incidence of bile leakage in patients with hepatolithiasis who can not remove all the stones during operation，and improve the stone clearance rate.