胆道探查术和胆肠吻合术治疗肝内胆管结石的临床研究

发布时间：2018-05-18 11:29

本文选题：肝内胆管结石 + 外科治疗　；参考：《昆明医科大学》2016年硕士论文

【摘要】：[目的]探讨肝内胆管结石外科治疗中胆道探查术和胆肠吻合术两种胆道手术方式的临床应用效果。[方法]回顾性分析我科2010年10月至2015年11月间外科手术治疗的89例肝内胆管结石患者的临床资料,依据是否伴有肝门部胆管狭窄而选择的手术方式分为胆道探查组和胆肠吻合组,比较两组一般资料、联合肝叶切除率、残石率、并发症发生率、远期疗效以及每组手术前、术后胆管炎发生率。[结果]①两组患者术前一般情况如性别、年龄、体重、肝功能、术前症状及体征、生化指标、结石分布、术前合并症、术前发生胆管炎等方面比较差异均无统计学意义(P0.05)。②联合肝叶切除率比较差异无统计学意义(P0.05)；③两组患者的残石率、术后并发症发生率及术后病理检查情况比较,差异均无统计学意义(P0.05)。④两组患者术前胆管炎发生率比较,差异无统计学意义；两组患者术前胆管炎发生率均高于术后。出院后随访,胆肠吻合组术后胆管炎发生率高于胆道探查组(P=0.03)；⑤两组患者术后结石复发率、胆道或吻合口狭窄率、癌变率、死亡率比较,差异均无统计学意义(P0.05)。[结论]1、胆道探查术和胆管空肠Roux-en-Y吻合术两种术式在术后结石残留率、并发症发生率、结石复发率及胆管癌发生率等方面比较,差异均无统计学意义,是治疗肝内胆管结石的有效手术方式。2、胆道探查术保留了Oddi括约肌功能,术后反流性胆管炎发生率较低,是治疗不伴有肝门部胆管狭窄的肝内胆管结石症的首选术式。3、胆管空肠Roux-en-Y吻合术治疗肝内胆管结石伴肝门部胆管狭窄效果确切,但因废除了Oddi括约肌功能,增加了术后发生反流性胆管炎的风险,应严格掌握其应用指征。
[Abstract]:Objective: to investigate the clinical effect of two kinds of biliary tract operation in surgical treatment of intrahepatic cholelithiasis: exploration of bile duct and choledochojejunostomy. [methods] the clinical data of 89 patients with intrahepatic cholelithiasis treated surgically from October 2010 to November 2015 were analyzed retrospectively. According to whether the hepatic hilar bile duct stricture was involved, the operative methods were divided into two groups: the exploration of biliary tract group and the choledochojejunostomy group. The general data of the two groups were compared, the rate of combined hepatectomy, the rate of residual lithiasis, the incidence of complications, the long-term curative effect and the pre-operation of each group were compared. Incidence of postoperative cholangitis. [results] 1the general preoperative conditions of the two groups were gender, age, body weight, liver function, preoperative symptoms and signs, biochemical indexes, distribution of stones, preoperative complications. There was no significant difference in the incidence of cholangitis between the two groups. There was no significant difference in the rate of liver lobectomy, the rate of residual stone, the incidence of postoperative complications and the pathological examination of the two groups. There was no significant difference in the incidence of preoperative cholangitis between the two groups, and the incidence of preoperative cholangitis in both groups was higher than that after operation. Following up after discharge, the incidence of postoperative cholangitis in choledochojejunostomy group was higher than that in bile duct exploration group (P < 0.03). There was no significant difference in the recurrence rate of gallstone, stricture rate of bile duct or anastomosis, canceration rate and mortality rate in two groups (P 0.05). [conclusion] 1. There was no significant difference in the residual rate of stone, the incidence of complications, the recurrence rate of stones and the incidence of cholangiocarcinoma between the two types of cholangiojejunostomy and choledochojejunostomy. Bile duct exploration retained Oddi sphincter function, and the incidence of postoperative reflux cholangitis was lower. It is the first choice for the treatment of intrahepatic cholelithiasis without hepatic hilar bile duct stricture. The effect of Roux-en-Y cholangiojejunostomy in the treatment of intrahepatic cholangiolithiasis with hilar bile duct stricture is definite, but the sphincter function of Oddi is abolished. The risk of reflux cholangitis after operation is increased, and the indication of its application should be strictly grasped.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.42

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