| Objective:The comparison is to identify the advantages of the hybrid operation, which is between the general surgery method group, group A,(lithotomy of extrahepatic bile duct, partial hepatectomy, choledochojejunostomy, lithotomy through endoscope that accompanied by other methods.) and the hybrid operation group, group B,(combined with holmium laser jointing choledochoscopy and the pillar-shaped balloon dilatation of bile duct).It includes the incidence of postoperative complications in two groups (such as sub-diaphragm and lung infections, biliary fistula, hemobilia/gastrointestinal bleeding, cholangitis), postoperative residual/recurrence rates of stones, average hospitalization day and postoperative calculus recurrence rate caused by intrahepatic biliary stricture.Method:There are300cases of hepatolithiasis patients, the medical records of which are accessed in nearly9years from Shan Xi Medical University Hospital, General Hospital of Taiyuan Iron and Steel Group Co.,Ltd, The General Hospital of the capital iron and steel Group Co.,Ltd.Patients with hepatolithiasis liver atrophy or liver fibrosis induced by recurrent infections, loss of liver function, and combination of liver carcinogenesis that needs to be cut, are excluded. By screening of200Patients with the same surgical indications and received the same surgical treatments, are classified to two groups, the general operation group and the hybrid operation group respectively, the number of which are statistically suitable.Then these patients selected are divided into two groups,(group A, general surgery method group and group B,the hybrid operation group, combined with holmium laser jointing choledochoscopy and the pillar-shaped balloon dilatation of bile duct), according to the different surgical approaches. Some aspects in group A and B cases are under statistical analysis respectively, such as the number of complications after surgery;postoperative hospitalization time; the number of stone recurrent/residual cases; the number of postoperative calculus recurrence cases caused by intrahepatic biliary stricture.These data are collected. The data obtained are analyzed by difference analysis with appropriate statistical methods.Results:Under the same surgery indications, the result, that can be inferred through this research, of the comparison between the two surgical groups is as follows:the residual stone rate (33.33%)/recurrence stone rate (25%) in general surgery group (group A) are higher than the hybrid operation group(holmium laser+choledochoscopy+pillar-shaped balloon dilatation of bile duct)(group B), the result of which is the residual stone rate (33.33%)/recurrence stone rate (25%), the comparison has statistics meaning (P<0.05); residual stone rates of group A:after choledochojejunostomy (33.33%), common bile duct exploration with choledochoscopy after choledocholithotomy+Tdrainage (35.29%), which were higher than group B (20.00%)(p<0.001); residual stone rate after hepatectomy group (26.92%) compared with group B (20%), with no statistically significant differences; recurrence rate of calculus in group A:hepatectomy group (30.8%), common bile duct exploration with choledochoscopy after choledocholithotomy+Tdrainage (23.53%), which were higher than group B (11.25%)(p<0.05); comparison between after choledochojejunostomy group and group B has no statistically significance (p>0.05); postoperative complication rate of group A is25.8%, higher than that of group B (13.8%)(p<0.05); hepatectomy group (34.62%), choledochojejunostomy group (33.33%) are higer than group B (13.8%)(p<0.05);comparison between common bile duct exploration with choledochoscopy after choledocholithotomy+T drainage group (22.35%) and group B with the incidence of complications had no significant difference; comparison between recurrence rate of postoperative calculus due to intrahepatic biliary stricture in group A (20%) and group B (2.5%) respectively, has a statistically significance (P<0.05), hepatectomy group (19.23%), common bile duct exploration with choledochoscopy after choledocholithotomy+T drainage group (22.35%) higher than group B (2.5%)(p<0.001); comparison between choledochojejunostomy group and group B has no statistically significance.(p>0.05);average length of stay:group A (12.96±2.81) and group B (11.6±2.32), the comparison between two groups has a statistically significance (T=3.6073,p=0.0004); more statistical data on group B, which includes the residual stone rate/recurrence of stone rate, postoperative complications rate, average length of stay and calculus recurrence rate associated with postoperative intrahepatic bile duct stenosis, are better than that of group A.Conclusion:Holmium laser lithotripsy technology with safety, high efficiency, small organization injury,fast recovery, at the same time, can make the stones in intrahepatic bile duct more easily to be removed, while combined with the method of choledochoscope and culumn-shaped balloon dilatation of bile duct, and also solve the problem of biliary stricture. The method makes rates of residual stone after biliary surgery and the reoperation rates decline. |
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