区段肝蒂肝切除术治疗肝胆管结石患者疗效及其血清白三烯B4和肝组织一氧化碳的变化  

Applicationof segmental hepatectomy for the treatment of patients with hepatolithiasis and effect on serum leukotriene and hepatic carbon monoxide levels

作　　者：许永华 王浩 秦呈林 臧书源 姜中华 王建华 查文章 Xu Yonghua;Wang Hao;Qin Chenglin(Department of General Surgery,First People's Hospital,Affiliated to Xuzhou Medical University,Yancheng 224000,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属盐城市第一人民医院普外科,江苏省盐城市224000 [2]徐州医科大学附属盐城市第一人民医院消化内科,江苏省盐城市224000

出　　处：《实用肝脏病杂志》2020年第6期913-916,共4页Journal of Practical Hepatology

基　　金：江苏省科技厅科研基金资助项目(编号:2017134)。

摘　　要：目的探讨采取区段肝蒂肝切除术治疗肝胆管结石患者的疗效及其血清白三烯B4(LTB 4)、肝组织一氧化碳(CO)和外周血T淋巴细胞亚群的变化。方法2015年1月~2019年12月我院普外科收治的肝胆管结石患者60例,随机分为观察组30例和对照组30例,分别采取区段肝蒂肝切除术和超声引导下肝切除术治疗。采用ELISA法测定血清LTB 4水平,术中,在腹部切口接气腹管,以便携式CO测定仪的探头直接测定肝组织CO浓度。结果观察组术中出血量为(351.7±104.2)mL,显著低于对照组[(492.6±153.8)mL,P<0.05],引流量为(279.8±79.2)mL,显著低于对照组[(361.7±113.7)mL,P<0.05];血清LTB 4水平为(22.6±11.7)ng/L,显著低于对照组[(43.5±12.2)ng/L,P<0.05],肝组织CO水平为(41.3±5.8)ppm,显著低于对照组[(65.5±4.3)ppm,P<0.05];观察组并发症发生率为23.3%,显著低于对照组的50.0%(P<0.05)。结论采取区段肝蒂肝切除术可有效降低肝胆管结石患者术中出血量和术后引流量,术后恢复快,可能与降低了术中炎症反应有关。Objective The purpose of this study was to investigate the application of segmental hepatectomy for the treatment of patients with hepatolithiasis and effect on serum leukotriene(LTB4)and hepatic carbon monoxide(CO)levels.Methods 60 patients with hepatolithiasis were admitted to our hospital between June 2015 and December 2019,and were randomly divided into observation(n=30)and control group(n=30).The patients in the observation group were treated with segmental hepatectomy,and those in the control group were treated with B-ultrasound-guided hepatectomy.Serum LTB4 and liver tissue CO were detected and compared in the two groups.Results The bleeding volume in the observation group was(351.7±104.2)mL,significantly lower than[(492.6±153.8)mL,P<0.05],and the drainage volume was(279.8±79.2)mL,much lower than[(361.7±113.7)mL,P<0.05]in the control;serum LTB4 level was(22.6±11.7)ng/L/l,significantly lower than t[(43.5±12.2)ng/L/l,P<0.05],and hepatic CO concentration was(41.3±5.8)ppm,much lower than[(65.5±4.3)ppm,P<0.05]in the control;the incidence of complications in the observation group was 23.3%,significantly lower than 50.0%in the control group(P<0.05).Conclusion The application of segmental hepatectomy could effectively reduce intraoperative blood loss,post-operational drainage,serum LTB4 level and hepatic CO concentration in patients with hepatolithiasis,which might be related to the inhibition of inflammatory reactions.

关 键 词：肝胆管结石 区段肝蒂肝切除术 白三烯B4 一氧化碳 并发症 

分 类 号：R657.3[医药卫生—外科学]