CT三维重建引导下输尿管镜联合钬激光碎石对肝内胆管结石的清除及肝功能分析  

Clearance of intrahepatic bile ducts and liver function analysis of ureteroscope combined with holmium laser lithotripsy under the guidance of three-dimensional CT reconstruction

作　　者：唐定 胡智强 邓洲子 TANG Ding;HU Zhi-qiang;DENG Zhou-zi(Department of Hepatobiliary Surgery,Third Hospital of Changsha City,Changha Hunan 410015,China)

机构地区：[1]长沙市第三医院肝胆外科,湖南长沙410015

出　　处：《临床和实验医学杂志》2022年第2期177-182,共6页Journal of Clinical and Experimental Medicine

基　　金：长沙市科技局基金项目(编号:kq1801124);湖南省卫健委科研课题项目(编号:B20182002)。

摘　　要：目的探讨CT三维重建引导下输尿管镜联合钬激光碎石治疗肝内胆管结石的效果。方法选取2019年7月至2020年10月长沙市第三医院接受手术治疗的130例复杂性肝内胆管结石患者作为研究对象进行回顾性分析,其中60例患者采用CT三维重建引导下输尿管镜联合钬激光碎石治疗(研究组)、70例患者采用规则性肝段或肝叶切除术治疗(对照组)。对比两组患者的手术时间、手术出血量、腹腔引流量、术后肛门排气时间、结石清除率、住院时间,手术前后患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、外周血白细胞(WBC)、空腹血糖(FBG)、C反应蛋白(CRP)水平的变化,对比两组患者的手术并发症情况。结果研究组的手术时间长于对照组,手术出血量、腹腔引流量、术后肛门排气时间、住院时间均低于对照组,差异均有统计学意义(P<0.05)。两组的结石清除率比较差异无统计学意义(P>0.05)。术前,两组的血清ALT、AST、TBIL水平比较,差异均无统计学意义(P>0.05);术后24、72h,研究组患者的血清ALT、AST、TBIL水平均低于对照组,差异均有统计学意义(P<0.05)。术前,两组的WBC、CRP、FBG水平比较,差异均无统计学意义(P>0.05);术后24、72h,研究组患者的血清CRP水平均低于对照组,差异均有统计学意义(P<0.05),而两组WBC、FBG水平比较,差异均无统计学意义(P>0.05)。研究组患者的手术并发症率6.67%与对照组的14.29%比较,差异无统计学意义(P>0.05)。结论CT三维重建引导下输尿管镜联合钬激光碎石治疗肝内胆管结石的效果与规则性肝段或肝叶切除术差异不大,但是前者手术创伤小、术后恢复快、对肝功能的影响更小。Objective To explore the effect of ureteroscope combined with holmium laser lithotripsy under the guidance of CT three-dimensional reconstruction in the treatment of intrahepatic bile duct stones.Methods A retrospective analysis of 130 patients with complicated intrahepatic bile duct stones who underwent surgical treatment in the Third Hospital of Changsha City from July 2019 to October 2020 was selected for retrospective analysis.Among them,60 patients underwent CT three-dimensional reconstruction guided ureteroscopy combined with holmium laser lithotripsy Treatment(study group),70 patients were treated with regular hepatic segment or lobectomy(control group),and the operation time,surgical blood loss,abdominal drainage,postoperative anal exhaust time,and stone removal were compared between the two groups rate,length of hospital stay,serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),peripheral white blood cells(WBC),fasting blood glucose(FBG)before and after surgery,C-reactive protein(CRP)level changes,and compare the surgical complications of the two groups of patients.Results The operation time of the study group was longer than that of the control group,the operation blood loss,abdominal drainage,postoperative anal exhaust time,and hospital stay in the study group were lower than those in the control group,the differences were statistically(P<0.05).There was no statistically significant difference in the stone clearance rate(P>0.05).Before operation,there was no significant difference in the levels of serum ALT,AST and TBIL between the two groups(P>0.05);24 h,72 h after operation,the levels of serum ALT,AST,and TBIL in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Before operation,the WBC,CRP,and FBG levels of the two groups were not statistically significant different(P>0.05);at 24 and 72 h after surgery,the serum CRP levels of patients in the study group were lower than those in the control group,

关 键 词：肝内胆管结石 CT 三维重建 输尿管镜 钬激光 

分 类 号：R657.4[医药卫生—外科学]