摘要
摘要：目的 探讨单纯胆总管切开胆道镜探查取石术治疗重症肝内胆管结石的临床疗效。 方法 选取 2017年 1月～ 2019年 6月在我院就诊的重症肝内胆管结石 128例，入院后按照抽签随机取样法将其分为对照组（ n=64）和观察组（ n=64）。对照组患者行开腹肝部分切除术；观察组患者行单纯胆总管切开胆道镜探查取石术。比较两组患者术中创伤及术后恢复指标。比较两组切口感染等术后并发症发生率及结石残留率，随访 1年，比较两组结石复发率。采手术前后不同时间段患者的血液进行 C反应蛋白的测量。比较两组治疗前后生活质量变化。结果 观察组患者术中创伤及术后恢复指标都少于对照组，有显著差异（ P<0.05）。观察组并发症发生率为 3.13%，对照组为 12.5%，两组比较，有显著差异（ χ2=3.905， P=0.048）；观察组结石残留率为 1.56%，对照组为 18.75%，两组比较，有显著差异（ χ2=10.360， P=0.000）；观察组结石复发率为 4.69%，对照组为 3.13%，两组比较，无显著差异（ χ2=0.177， P=1.000）。结论 单纯胆总管切开胆道镜探查取石术对重症肝内胆管结石患者的治疗效果优于开腹肝部分切除术，有利于患者的术后恢复，减少术后并发症的发生率，降低手术造成的机体炎性应激反应程度。 关键词：重症肝内胆管结石；开腹肝部分切除术；单纯胆总管切开胆道镜探查取石术 Abstract: Objective To explore the clinical effect of choledochotomy and choledochoscopy in the treatment of severe intrahepatic cholelithiasis. Methods from January 2017 to June 2019, 128 patients with severe intrahepatic cholelithiasis were randomly divided into control group (n = 64) and observation group (n = 64). The patients in the control group underwent partial hepatectomy, while those in the observation group underwent choledochotomy and choledochoscopy. The intraoperative trauma and postoperative recovery were compared between the two groups. The incidence of postoperative complications such as incision infection and the residual rate of stones were compared between the two groups, and the recurrence rate of stones was compared after 1 year follow-up. C-reactive protein was measured before and after operation. The quality of life of the two groups before and after treatment was compared. Results the indexes of intraoperative trauma and postoperative recovery in the observation group were significantly lower than those in the control group (P < 0.05). The incidence of complications was 3.13% in the observation group and 12.5% in the control group. There was a significant difference between the two groups (χ 2 = 3.905, P = 0.048); the residual rate of stones was 1.56% in the observation group and 18.75% in the control group. There was a significant difference between the two groups (χ 2 = 10.360, P = 0.000); the recurrence rate of stones was 4.69% in the observation group and 3.13% in the control group. There was no significant difference between the two groups (χ 2 = 0.177, P = 1.000). Conclusion simple choledochotomy and choledochoscopy is better than open partial hepatectomy in the treatment of severe intrahepatic cholelithiasis, which is conducive to the postoperative recovery of patients, reduce the incidence of postoperative complications, and reduce the degree of inflammatory stress caused by surgery.
出版日期
2020年01月09日（中国Betway体育网页登陆平台首次上网日期，不代表论文的发表时间）
