The Choice Of Surgical Methods And Effects Of Diffuse Intrahepatic Bile Duct Stones

Objective To explore the treatment of diffuse intrahepatic bile duct stones in different surgical treatment of the difference,summed up the analysis of diffuse hepatolithiasis treatment experience,choose a reasonable way to deal with clinical problems encountered,reduce the residual stones and recurrence,reduce postoperative complications Disease,to ensure the improvement of postoperative life of patients.Methods Of patients with diffuse intrahepatic bile duct stones who were hospitalized in Qingda Affiliated Hospital from January 2013 to December 2015,patients were divided into non-hepatectomy group(group A,n = 30),liver resection(Group B,n = 88).The patients were divided into three groups: group A(n = 30)and group B(n = 55).To compare the effects of different surgeries and treatments in this study:(1)the manner in which the patient is operated.(2)intraoperative conditions: duration of surgery,total bleeding,stone residue.(3)postoperative complications: postoperative complications and treatment,postoperative hospital stay.(4)follow-up results.Using outpatient,re-admission and telephone follow-up to monitor the recurrence of patients with postoperative stone and life status.Results(1)the way the patient operates :Non-hepatectomy group(Group B,n = 30);liver resection combined treatment group(group B,n = 88),group B1 was combined with hepatic resection group of 33 cases,group B2 was left liver Resection group of 55 cases.(2)The operation time of group B1 was(224.97 ± 29.72)min,the operation time of group B2 was(181.22 ± 12.50),the operation time of group A was(161.47 ± 19.84)min,(P <0.05).There was significant difference between B1 and B2(P <0.05).The blood loss in group B1 was(386.56 ± 90.84)ml,(P <0.05).There were significant differences between the two groups(P> 0.05).There was significant difference between the two groups(P> 0.05),and the difference between the two groups was statistically significant(P <0.05)(P <0.05).The residual rate of calculus was 12.50%(11/88)in group B and 63.33 in group A(P <0.05).The residual rate of stones in group A was 63.33(P <0.05).The residual rate of stones in group B1 was 3.03%(1/33),and that of group B2 was 18.18%(10%),and the difference was statistically significant(P <0.05)(P <0.05).(3)Postoperative cases:Among the 118 patients,24 cases had postoperative complications,and the patients underwent hepatectomy Complications occurred in 22 cases,7 cases of incision 4 patients with pleural effusion after effective anti-infection,B-guided thoracic puncture drainage and enhanced nutritional support and other treatment were successfully discharged after the patients were treated with wound drainage,anti-infection and support after treatment improved,no other special treatment.5 patients with biliary fistula were discharged after drainage through the abdominal drainage tube.2 cases of pulmonary infection in patients with anti-infection and nutritional support after treatment were discharged.1 cases of postoperative liver abscess formation of patients,given infusion of albumin,anti-infection,Nutritional support,puncture and drainage and other related treatment after recovery.1 cases of biliary bleeding patients,given homeostatic drugs and other conservative treatment after treatment;2 patients with liver failure after conservative treatment improved;the incidence of postoperative complications in group B1 was 12.12 %(4/33),the complication rate was 32.73%(18/55).The complication rate in group A was 6.67%(2/30),There were significant differences between A and B(P <0.05).There were significant differences between B1 and B2(P <0.05).The results of pathologic examination were 88 cases of liver lesions of hepatolithiasis.The length of hospital stay was(17.31 ± 2.63)d in the B1 group and(15.86 ± 1.42)d in the B2 group.The postoperative hospital stay was(15.20 ± 1.84)d in group A,The difference was statistically significant(P <0.05).There was no significant difference between B1 and B2 groups(P> 0.05).The recurrence rate was 13.32%(17/88)in group B and 33.33%(10/30)in group A,and the difference was statistically significant(P <0.05).The recurrence rate was 6.06%(2/33)in group B1 and 27.27%(15/55)in group B2,and the difference was significant(P <0.05).(4)Follow-up results: 118 patients were followed up for 12-48 months after follow-up,follow-up visits,follow-up visits and follow-up visits.During the follow-up period,63 patients had excellent postoperative status,and 55 patients had poor postoperative status(32 patients underwent hepatectomy and 22 patients after non-hepatectomy).The excellent and good rate was 62.5%(55/88)in group B,26.67%(8/30)in group A,and the difference was statistically significant(P <0.05).The excellent and good rate of group B1 was 75.76%(25/33).The excellent and good rate of group B2 was 54.55%(30/55),and there was significant difference between B1 and B2(P <0.05).ConclusionFor patients with diffuse hepatolithiasis,individualized,comprehensive and regular combined liver resection can effectively remove the lesion.The residual rate of stone and the recurrence rate are low,which can improve the long-term quality of life.