两种腹腔镜不同取石术式对胆总管结石患者肝功能及GSRS评分的影响?  

Effect of two different laparoscopic lithotripsy methods on liver functions of patients with choledocholithiasis and GSRS

作　　者：冯钟煦[1] 孟维山 苏忠[1] 杨涛[1] 李高岩[1] FENG Zhongxu;MENG Weishan;SU Zhong;YANG Tao;LI Gaoyan(Department of General Surgery,the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市第一医院普通外科,河北秦皇岛066000

出　　处：《贵州医科大学学报》2022年第9期1087-1091,1096,共6页Journal of Guizhou Medical University

基　　金：秦皇岛市科技计划项目(202004A042)。

摘　　要：目的比较腹腔镜经胆囊管胆总管探查取石术(LTCBDE)与腹腔镜胆总管切开探查取石术(LCBDE)对患者肝功能、胃肠道症状评定量表(GSRS)评分的影响。方法160例胆总管结石患者根据手术方法均分为LCBDE组和LTCBDE组,比较2组患者住院时间、术后补液量、住院费用、手术时间、术中出血量、临床疗效及术后近期和远期的并发症,于手术前及术后第1天检测2组患者血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(γ-GT)水平,比较手术前及术后1周时2组患者的GSRS评分。结果LTCBDE组患者住院时间、术后补液量、住院费用、手术时间、术中出血量低于LCBDE组,LTCBDE组患者临床疗效(97.50%)高于LCBDE组(76.25%),差异具有统计学意义(P<0.05);术前2组患者GSRS评分及血清AST、ALT、γ-GT水平比较,差异无统计学意义(P>0.05);术后2组患者GSRS评分及血清AST、ALT、γ-GT水平均较治疗前降低,且LTCBDE组降低更为显著,差异有统计学意义(P<0.05);2组患者术后近远期并发症发生率比较,差异无统计学意义(P>0.05)。结论LTCBDE治疗胆总管结石的临床疗效较LCBDE更好,能改善胃肠道及肝功能,在满足适应症情况下,具有较好的临床应用价值。Objective To compare the therapeutic effects of laparoscopic transcystic duct common bile duct exploration(LTCBDE)and laparoscopic duct common bile duct exploration(LCBDE)in treating choledocholithiasis and the effects on liver functions and gastrointestinal symptom rating scale(GSRS).Methods A total of 160 patients with common bile duct stones were divided into LCBDE and LTCBDE groups according to the operation methods.The length of hospital stay,postoperative fluid volume,hospitalization cost,operation time,intraoperative blood loss,clinical efficacy,and short-term and long-term postoperative complications were compared between two groups.GSRS and the levels of serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),andγ-glutamyl transpeptidase(γ-GT)were compared between two groups before operation and 1 week after operation.Results The length of hospital stay,postoperative fluid volume,hospitalization cost,operation time,and intraoperative blood loss group were lower in LTCBDE than those in LCBDE group.In LTCBDET group versus LCBDE group,clinical efficacy was 97.50%versus 76.25%(P<0.05).There were no significant differences in GSRS and serum AST,ALT andγ-GT levels between two groups before operation(P>0.05).After operation,GSRS and serum AST,ALT,γ-GT levels in two groups were significantly lower than those before treatment,and the decrease was more obvious in LTCBDE group(P<0.05).There were no significant differences in the short-term and long-term postoperative complications between two groups(P>0.05).Conclusion The clinical efficacy of LTCBDE in treating choledocholithiasis is better than that of LCBDE.LTCBDE can improve gastrointestinal and liver functions,and has better clinical application value when the indications are met.

关 键 词：腹腔镜 腹腔镜经胆囊管胆总管探查取石术 腹腔镜胆总管切开探查术 胆总管结石 微创手术 

分 类 号：R657.4[医药卫生—外科学]