精准肝切除与非规则性肝切除治疗肝内胆管结石效果比较  

Comparison of effects of precise hepatectomy and irregular hepatectomy in treatment of hepatolithiasis

作　　者：辛大平 彭彬[1] 黄明 黄纪伟[2] XIN Daping;PENG Bin;HUANG Ming;HUANG Jiwei(The First Department of General Surgery,Guang′an People′s Hospital,Guang′an,Sichuan 638000;Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041)

机构地区：[1]广安市人民医院普外一科,四川广安638000 [2]四川大学华西医院肝脏外科,成都610041

出　　处：《郑州大学学报（医学版）》2019年第5期762-765,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：四川省卫生和计划生育委员会基金项目(17PJ007)

摘　　要：目的:比较精准肝切除与非规则性肝切除治疗肝内胆管结石的效果。方法:胆管结石患者100例,50例行非规则性肝切除治疗(对照组),50例给予精准肝切除治疗(观察组),比较两组手术时间、术中出血量、住院时间、住院费用,肝功能指标[丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、总胆红素(TBIL)]、血清学指标(NF-κB、IL-17、IL-23)、应激指标[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)]的变化及并发症发生率。结果:观察组的手术时间长于对照组,住院时间均短于对照组,术中出血量和住院费用少于对照组(P<0.001)。观察组治疗前后血清ALT、ALP、TBIL差值和血清NF-κB、IL-17、IL-23、Cor、E、NE差值均小于对照组(P<0.001)。观察组并发症发生率为10.0%,低于对照组的34.0%(P<0.001)。结论:精准肝切除治疗肝内胆管结石效果显著,安全性较高。Aim:To observe the curative effects of precise hepatectomy and irregular hepatectomy in the treatment of hepatolithiasis.Methods:A total of 100 patients with hepatolithiasis were allocated into control group(n=50)and the observation group(n=50).The control group was treated by irregular hepatectomy while the observation group was treated by precise hepatectomy.The surgical time,intraoperative blood loss,length of hospital stay,hospitalization expenses,liver function indexes[alanine aminotransferase(ALT),alkaline phosphatase(ALP),total bilirubin(TBIL)],serological markers(NF-κB,IL-17,IL-23),stress indexes[cortisol(Cor),adrenaline(E),norepinephrine(NE)]and the incidence of complications were compared between the two groups.Results:The surgical time of the observation group was longer than that of the control group,and the length of hospital stay was shorter than that of the control group(P<0.001).The intraoperative blood loss and hospitalization expenses of the observation group were less than those of the control group(P<0.001).After treatment,the differences of ALT,ALP,TBIL,NF-κB,IL-17,IL-23,Cor,E and NE in the observation group were significantly lower than those in the control group(P<0.001).The total incidence of complications in the observation group was significantly lower than that in the control group(10.0%vs 34.0%,P<0.001).Conclusion:Precise hepatectomy is effective in the treatment of hepatolithiasis with high safety.

关 键 词：肝内胆管结石 精准肝切除 非规则性肝切除 

分 类 号：R657.3[医药卫生—外科学]