肝叶切除加“T”管引流术与胆总管空肠Roux-en-Y吻合术治疗肝内胆管结石临床对比研究

摘要

Objective To compare the clinical effect of hepatic lobe resection with“T”tube drainage and bile duct-jejunum Roux en-Y anastomosis in the treatment of patients with intrahepatic bile duct calculi. Methods From January 2011 to January 2015,80 cases of intrahepatic biliary calculi patients were randomly divided into hepatic lobe resection with “T”tube drainage group (n=39),and common bile duct-jejunum Roux en-Y anastomosis group (n=41). Results The early postoperative residual stones was 7 (18.0%),infection of incision 4 (10.3%),abdominal cavity infection 6(15.4%),bile leakage 4(10.3%) in hepatic lobe resection,while they were 8(19.5%,P>0.05),5(12.2%,P>0.05),6(14.6%,P>0.05),and 4(9.8%,P>0.05);the postoperative residual cholangitis (8.3%),stone with bile duct calculi recurrence(4.2%),anastomotic stenosis(4.2%) in patients receiving hepatic lobe resection were significantly lower than in bile duct-jejunum Roux en-Y anastomosis group (24.4%, 19.5%,7.3% and 22.0%,respectively,P<0.05);the serum bilirubin levels in hepatic lobe resection group were (10.87±2.36)μmol/l,ALT were(38.96±10.28) U/L,AST were(34.76±5.47) U/L and ALP were(108.04±23.40) U/L,significantly lower than in bile duct-jejunum Roux en-Y anastomosis group ([(18.96±2.01)μmol/l,(76.83±15.67) U/L,(45.54±4.58) U/L and (176.42±34.58) U/L,respectively,P<0.05]. Conclusion Hepatic lobe resection with “T”tube drainage in the treatment of patients with intrahepatic bile duct stones is effective with lower incidence of complications and improved liver function.%目的：探讨肝叶切除加“T”管引流术与胆总管空肠Roux-en-Y吻合术治疗肝内胆管结石的临床效果，评价手术的优越性。方法选择我院2011年1月至2015年1月收治的80例肝内胆管结石患者，采用随机数字表法分为肝叶切除加“T”管引流术组和胆总管空肠Roux-en-Y吻合术组，比较两组患者近期并发症、远期并发症和肝功能指标。结果39例肝叶切除患者术后早期出现残留结石7例（18.0%）、切口感染4例（10.3%）、腹腔感染6例（15.4%）、胆漏4例（10.3%），而41例空肠Roux-en-Y吻合患者则分别为8例（19.5%，P>0.05）、5例（12.2%， P>0.05）、6例（14.6%，P>0.05）、4例（9.8%，P>0.05）；肝叶切除患者术后出现残胆管炎（8.3%）、结石复发（4.2%）、结石合并胆管炎（4.2%）、吻合口狭窄（4.2%）的比较明显低于空肠Roux-en-Y吻合患者（分别为24.4%、19.5%、7.3%、22.0%，P<0.05）；治疗后，肝叶切除患者血清TBIL为（10.87±2.36）μmol/L、ALT为（38.96±10.28） U/L、AST为（34.76±5.47） U/L、ALP为（108.04±23.40） U/L，而空肠Roux-en-Y吻合患者则分别为（18.96±2.01）μmol/L、（76.83±15.67） U/L、（45.54±4.58） U/L、（176.42±34.58） U/L（P<0.05）。结论肝叶切除加“T”管引流术治疗肝内胆管结石患者疗效显著，远期并发症发生率较低。