循肝中静脉腹腔镜左半肝切除联合胆道镜取石术治疗左肝内胆管结石的效果  

Effect of Laparoscopic Left Hemihepatectomy through the Middle Hepatic Vein Combined with Choledochoscope Lithotomy in the Treatment of Left Intrahepatic Bile Duct Stones

作　　者：王楷 吴腾飞 黄思辉 司自敏 邱振雄 WANG Kai;WU Tengfei;HUANG Sihui;SI Zimin;QIU Zhenxiong(Bao’an District Central Hospital in Shenzhen,Guangdong Province,Shenzhen 518100,China;不详)

机构地区：[1]广东省深圳市宝安区中心医院(广东医科大学附属宝安中心医院),广东深圳518100

出　　处：《中国医学创新》2022年第31期38-42,共5页Medical Innovation of China

基　　金：深圳市宝安区科技计划基础研究项目(2021JD083)。

摘　　要：目的:研究左肝内胆管结石应用胆道镜取石术联合循肝中静脉腹腔镜左半肝切除治疗的效果。方法:研究对象选取深圳市宝安区中心医院2016年1月-2020年1月收治的83例左肝内胆管结石患者,按随机数字表法将其分为对照组(41例)与试验组(42例),分别行开腹左半肝切除术联合胆道镜取石术、循肝中静脉腹腔镜左半肝切除联合胆道镜取石术,对比围手术期指标、结石残留情况、并发症、肝功能及疼痛度。结果:与对照组比较,试验组术后排气、引流管拔除、下床活动时间更早,住院时间更短,术中出血量更少(t=4.071、6.499、7.422、4.666、3.796,P<0.05);与对照组比较,试验组术后3 d谷草转氨酶(ALT)、谷丙转氨酶(AST)、总胆红素(TBIL)及凝血酶原时间(APTT)水平更低,白蛋白(ALB)水平更高(t=3.416、8.367、4.249、4.613、4.777,P<0.05);结石残留率比较,对照组为12.20%,高于试验组的4.76%,但差异无统计学意义(χ^(2)=1.484,P>0.05);并发症发生率比较,对照组为31.71%,高于试验组的7.14%(χ^(2)=8.045,P<0.05);试验组术后3、5、7 d的VAS评分均低于对照组(t=5.714、3.755、6.996,P<0.05)。结论:左肝内胆管结石应用循肝中静脉腹腔镜左半肝切除联合胆道镜取石术治疗,可缩短术后恢复时间,减少并发症,改善患者肝功能,术后疼痛度较轻。Objective:To study the effect of choledochoscope lithotomy combined with laparoscopic left hemihepatectomy through the middle hepatic vein for left intrahepatic bile duct stones.Method:A total of 83 patients with left intrahepatic bile duct stones who were admitted to Bao’an District Central Hospital in Shenzhen from January 2016 to January 2020 were selected.They were divided into control group (41 cases) and experimental group (42 cases) by random number table method.The patients underwent left hepatectomy combined with choledochoscope lithotomy,laparoscopic left hepatectomy through middle hepatic vein combined with choledochoscopy lithotomy,respectively.Perioperative indicators,residual calculus,complications,liver function and pain were compared.Result:Compared with the control group,the experimental group had earlier postoperative exhaust,drainage tube removal,getting out of bed and shorter hospital stay,and less intraoperative blood loss (t=4.071,6.499,7.422,4.666,3.796,P<0.05).Compared with the control group,the experimental group had lower levels of ALT,AST,TBIL and APTT 3 days after operation,and higher ALB levels (t=3.416,8.367,4.249,4.613,4.777,P<0.05).The residual rate of stones in the control group was 12.20%,which was higher than 4.76% in the experimental group,but the difference was not statistically significant (χ^(2)=1.484,P>0.05).The incidence of complications in the control group was 31.71%,which was higher than 7.14% of the experimental group (χ^(2)=8.045,P<0.05).The VAS scores of the experimental group was lower than that of the control group at 3,5 and 7 d after operation (t=5.714,3.755,6.996,P<0.05).Conclusion:The application of laparoscopic left hemihepatectomy through middle hepatic vein combined with choledochoscope lithotomy for the treatment of left intrahepatic bile duct stones can shorten the postoperative recovery time,reduce complications,and improve the liver function of patients with less postoperative pain.

关 键 词：左肝内胆管结石 胆道镜取石术 循肝中静脉腹腔镜左半肝切除术 切口感染 胆漏 疼痛度 

分 类 号：R657.42[医药卫生—外科学]