CAJ | 학술논문

目的：比较肝部分切除联合胆肠吻合术与 T 管引流术治疗肝内胆管结石的临床疗效。方法选取肝内胆管结石患者72例，按数字表法将患者随机分为观察组和对照组，观察组行肝叶切除＋胆管空肠吻合术治疗，对照组行肝叶切除＋T 管引流术治疗。观察两组手术时间、术中出血量、下地功能锻炼时间、住院时间、复发率、临床疗效评估及并发症发生情况。结果对所有患者行6～12个月随访，观察组手术时间（158．29±32．53）min、术中出血量（161．42±11．75）mL、下地功能锻炼时间（3．61±0．28）d、住院时间（5.31±1．17）d ，均明显多于对照组的手术时间（127．57±26．38）min、术中出血量（78．29±8．36）mL、下地功能锻炼时间（2．25±0．56）d、住院时间（4.86±2．39）d，而观察组术后12个月随访期间结石复发率（5．56％）却低于对照组（16．67％），比较差异均有统计学意义（t ＝4．328、7．196、2．174、2．259、1．862，均 P ＜0．05）；观察组治疗后临床疗效优良率（94.44％）略高于对照组（83．33％），比较差异有统计学意义（χ2＝1．257，P ＜0.05）；观察组术后出现并发症6例（16．67％），其中切口感染1例，膈下感染2例，胆漏2例，肺部感染1例；对照组术后出现并发症15例（41．67％），其中切口感染3例，胆漏4例，胆道出血3例，腹腔出血1例，肺部感染2例、膈下感染1例，胸腔积液1例，两组比较差异有统计学意义（χ2＝2．291，P ＜0．05）。结论肝部分切除术是治疗肝内胆管结石的有效手段，在肝切除的基础上采用胆肠吻合术治疗肝内胆管结石远期效果更佳，可有效预防肝内胆管结石的复发及胆管癌变。
목적：비교간부분절제연합담장문합술여 T 관인류술치료간내담관결석적림상료효。방법선취간내담관결석환자72례，안수자표법장환자수궤분위관찰조화대조조，관찰조행간협절제＋담관공장문합술치료，대조조행간협절제＋T 관인류술치료。관찰량조수술시간、술중출혈량、하지공능단련시간、주원시간、복발솔、림상료효평고급병발증발생정황。결과대소유환자행6～12개월수방，관찰조수술시간（158．29±32．53）min、술중출혈량（161．42±11．75）mL、하지공능단련시간（3．61±0．28）d、주원시간（5.31±1．17）d ，균명현다우대조조적수술시간（127．57±26．38）min、술중출혈량（78．29±8．36）mL、하지공능단련시간（2．25±0．56）d、주원시간（4.86±2．39）d，이관찰조술후12개월수방기간결석복발솔（5．56％）각저우대조조（16．67％），비교차이균유통계학의의（t ＝4．328、7．196、2．174、2．259、1．862，균 P ＜0．05）；관찰조치료후림상료효우량솔（94.44％）략고우대조조（83．33％），비교차이유통계학의의（χ2＝1．257，P ＜0.05）；관찰조술후출현병발증6례（16．67％），기중절구감염1례，격하감염2례，담루2례，폐부감염1례；대조조술후출현병발증15례（41．67％），기중절구감염3례，담루4례，담도출혈3례，복강출혈1례，폐부감염2례、격하감염1례，흉강적액1례，량조비교차이유통계학의의（χ2＝2．291，P ＜0．05）。결론간부분절제술시치료간내담관결석적유효수단，재간절제적기출상채용담장문합술치료간내담관결석원기효과경가，가유효예방간내담관결석적복발급담관암변。
Objective To compare the clinical curative effect of partial hepatectomy combined with biliary intestinal anastomosis and T tube drainage in the treatment of intrahepatic stones.Methods 72 patients with intrahe-patic stones were selected and randomly divided into observation group and control group.The observation group received lobectomy of liver +bile duct jejunum anastomosis,the control group received lobectomy of liver +T tube drainage treatment.The operation time,intraoperative blood loss,functional exercise time,length of hospital stay, recurrence rate,clinical efficacy and complications were observed.Results The patients were followed up for 6 -12months.The operative time,blood loss,ambulation exercise time,length of hospital stay in the observation group were (158.29 ±32.53)min,(161.42 ±11.75)mL,(3.61 ±0.28)d,(5.31 ±1.17)d,which were significantly more than those in the control group[(127.57 ±26.38)min,(78.29 ±8.36)mL,(2.25 ±0.56)d,(4.86 ± 2.39)d].The recurrence rate of stone of the observation group during the postoperative follow -up was 5.56%, which was significantly lower than 16.67% of the control group (t =4.328,7.196,2.174,2.259,1.862,all P <0.05).The excellent and good rate of the observation group was 94.44%,which was higher than 83.33% of the control group,the difference was statistically significant (χ2 =1.257,P <0.05).6 cases in the observation group had complications (16.67%),including 1 case of incision infection,subphrenic infection in 2 cases,bile leakage in 2 cases,1 case of pulmonary infection.15 cases in the control group had postoperative complications (41.67%), including 3 cases of wound infection,bile leakage in 4 cases,3 cases of biliary tract bleeding,abdominal bleeding in 1 case,2 cases of pulmonary infection,subphrenic infection in 1 case,pleural effusion in 1 case,the difference between the two groups was significant (χ2 =2.291,P <0.05).Conclusion Liver resection is an effective method for treatment of intrahepatic bile duct stones,on the basis of liver resection by intestinal anastomosis in the treatment of intrahepatic bile duct stone long -term effect is better,which can effectively prevent recurrence of the intrahepatic bile duct stone and bile duct cancer,widely used in patients with indications for clinical physicians.