Analysis Of Surgical Effect Of Different Types Of Intrahe Patic Bile Duct Stones

Objective:Patients with intrahepatic bile duct calculi have various diseases due to different growth sites,different number of calculi and different duration of disease.It has been pointed out in the literature that the unreasonable choice of surgical timing and surgical method is the main reason for postoperative stone residual and recurrence.Therefore,patients with intrahepatic bile duct stone should develop an appropriate individualized treatment plan under the principle of "removing the lesion,removing the stone,correcting the stenosis,unobstruction of drainage and preventing recurrence".In this article,through statistical analysis of different types of intrahepatic biliary calculi surgery after evaluation index(intraoperative bleeding,operation time,postoperative complications and length of hospital stay,postoperative recurrence rate of residual stones,stones),to study the efficacy of operation of different kinds of intrahepatic bile duct stones,for the surgical treatment of intrahepatic bile duct stones method provide a new train of thought.Methods:A total of 123 patients with intrahepatic bile duct calculi admitted from January 2015 to December 2020 were selected.All patients met the diagnostic criteria for intrahepatic bile duct calculi,were approved by the Medical Ethics Committee,and signed the informed consent.Exclusion criteria:(1)complicated with severe organic heart and lung disease,basic disease;(2)patients with cholangiocarcinoma,liver cancer or suspected cancer diagnosis;(3)Other surgical contraindications.There were no significant differences in age,sex and onset time among all groups(P BBB 00.05).According to the classification method of the guidelines for diagnosis and treatment of hepatobiliary duct disease issued by the Chinese Medical Association in 2007,the patients in the whole group were classified(72 cases of type I,29 cases of type IIA,22 cases of type ⅡB,a total of 123 cases).Whole group of patients with surgical procedure including:resection of liver,bile duct exploration+T tube drainage,bravery intestinal anastomosis of treatment,the operation of the patients were observed,including the incidence of intraoperative bleeding,operation time,postoperative complications,hospital stay,postoperative residual rate,stones recurrence rate,the collected data using statistical software SPSS23.0 statistical analysis,the accord with normal distribution measurement data contrast using analysis of variance between groups,such as:Counting data,such as postoperative complication rate,stone residual rate and stone recurrence rate,such as operative time,intraoperative blood loss and postoperative hospitalization time,were tested by chi-square test,and P<0.05 was considered statistically significant.The results are analyzed and discussed,and the final conclusion is drawn.Results:(1)There were no significant differences in operative time(P=0.389),intraoperative blood loss(P=0.882)and postoperative hospital stay(P=0.953)between type Ⅰ and type Ⅱ intrahepatic bile duct stones.The incidence of postoperative complications and stone residual rate of type Ⅰ(40.3%,8.3%)were significantly lower than those of type Ⅱ(60.8%,29.4%)(P<0.05),while the recurrence rate of stone(24.2%;Type Ⅱ:22.2%)there was no significant difference between them.(2)The operative time,intraoperative blood loss and postoperative hospital stay in the biliary duct exploration group(189.0180.0min,37.3±15.2ml,10.5±7.5d)were all lower than those in the hepatectomy group(234.8±92.1 min,163.0±100.3ml,14.4±6.7d),and the difference was statistically significant(P<0.05).Hepatectomy group was better than biliary duct exploration group in the rate of stone residual and stone recurrence(2.2%,15.2%),the difference was statistically significant(P<0.05),but the incidence of postoperative complications in the two groups(biliary duct exploration group:33.3%;Hepatectomy group:45.7%)there was no significant difference.(3)For type II intrahepatic bile duct stones,the operative time and postoperative hospital stay in the biliary duct exploration group(205.7±74.0min,11.4±6.1d)were significantly lower than those in the choledojejunostomy group(294.6±125.5min,17.9±9.6d),and the results were statistically significant(P<0.05).The incidence of postoperative complications in the biliary duct exploration group(A),hepatectomy group(B),and choleojejunostomy group(C)(A:52.2%;B:66.7%;C:61.5%)and the recurrence rate of calculi(A:26.7%;B:15.4%;C:21.4)there was no statistical significance(P>0.05).There were significant differences in the stone residual rate between group B(0%)and group A(43.5%),group B(0%)and group C(38.5%),with statistical significance(P<0.05),while there was no significant difference between group A(43.5%)and group C(38.5%).Conclusions:1.The incidence of postoperative complications and residual stones of type I intrahepatic bile duct stones was lower than that of type II intrahepatic bile duct stones,but there was no significant difference in the recurrence rate of stones between the two.2.Hepatectomy is the first choice for type I intrahepatic bile duct stones.3.There is no standard treatment for type Ⅱ intrahepatic bile duct stones,which should be combined with the situation or further classification.