腹腔镜肝切除术与经皮经肝穿刺胆道镜取石术治疗肝内胆管结石患者效果比较  

Comparison of laparoscopic hepatectomy and percutaneous transhepatic choledochoscopic lithotomy in the treatment of patients with intrahepatic bile duct stones

作　　者：祝立刚 汪涛 周魏巍 何彦安 程龙 Zhu Ligang;Wang Tao;Zhou Weiwei(Department of Hepatobiliary Surgery,Jiangyou People's Hospital,Affiliated to Chuanbei Medical College,Jiangyou 621700,Sichuan Province,China)

机构地区：[1]川北医学院附属江油医院肝胆外科,四川省江油市621700 [2]解放军西部战区总医院普通外科

出　　处：《实用肝脏病杂志》2023年第3期436-439,共4页Journal of Practical Hepatology

基　　金：四川省科技厅科研青年基金资助项目(编号:2016JQ0023)。

摘　　要：目的 比较腹腔镜肝切除术与经皮经肝穿刺胆道镜取石术治疗肝内胆管结石患者的临床效果。方法 2019年6月~2022年6月我院收治的86例肝内胆管结石患者,其中41例观察组接受腹腔镜肝切除术,45例对照组接受经皮经肝穿刺胆道镜取石术治疗。采用化学发光免疫分析法检测血清皮质醇(COR)和肾上腺素(EP)水平。术后,使用彩色超声诊断仪行腹部超声检查。结果 观察组手术时间、术中出血量、肛门排气时间和术后住院时间分别为(152.1±21.9)min、(93.2±18.3)ml、(1.2±0.6)d和(4.6±0.8)d,均显著短于或少于对照组【分别为(181.6±26.3)min、(149.6±20.1) ml、(1.7±0.8)d和(6.9±1.2)d,P<0.05】;在术后3 d,观察组血清ALT、AST、TBIL、COR和EP水平分别为(42.8±6.4)U/L、(35.6±5.1)U/L、(16.6±2.1)μmol/l、(359.2±34.4)nmol/ml和(253.2±24.6)pg/ml,均显著低于对照组【分别为(56.5±6.7)U/L、(45.8±5.9)U/L、(24.8±2.6)μmol/l、(472.6±41.3)nmol/ml和(316.8±30.3)pg/ml,P<0.05】;术后,观察组切口感染、腹腔积液、胆道感染、胆漏和胆道出血等并发症发生率为9.8%,显著低于对照组的26.7%(P<0.05);在术后3 m行超声检查,发现观察组结石残留或复发率为2.4%,显著低于对照组的15.6%(P<0.05)。结论 采取腹腔镜肝切除术治疗肝内胆管结石患者疗效好,术后并发症少,相对从根本上解决了术后结石复发的问题。Objective The aim of this study was to compare the clinical efficacy of laparoscopic hepatectomy(LH)and percutaneous transhepatic choledochoscopic lithotomy(PTCL)in the treatment of patients with intrahepatic bile duct stones.Methods 86 patients with intrahepatic bile duct stones were enrolled in our hospital between June 2019 and June 2022,and among them,41 patients in observation group underwent LH and 45 patients in control group underwent PTCL.Serum cortisol(COR)and epinephrine(EP)levels were detected by chemiluminescence.All patients after operation were followed-up by ultrasonography.Results The surgical time,intraoperative blood loss,anal exhaust time and postoperative hospital stay in the observation group were(152.1±21.9)min,(93.2±18.3)ml,(1.2±0.6)d and(4.6±0.8)d,all significantly shorter or less than[(181.6±26.3)min,(149.6±20.1)ml,(1.7±0.8)d and(6.9±1.2)d,respectively,P<0.05]in the control;3 days after operation,serum ALT,AST,total bilirubin,COR and EP levels in the observation group were(42.8±6.4)U/L,(35.6±5.1)U/L,(16.6±2.1)μmol/l,(359.2±34.4)nmol/ml and(253.2±24.6)pg/ml,all significantly lower than[(56.5±6.7)U/L,(45.8±5.9)U/L,(24.8±2.6)μmol/l,(472.6±41.3)nmol/ml and(316.8±30.3)pg/ml,respectively,P<0.05]in the control;after operation,the incidences of complications,such as infection,ascites,bile leak and bleeding,in the observation was 9.8%,much lower than 26.7%(P<0.05)in the control;3 months after operation,the residual or relapse of stones revealed by ultrasonography in the observation was 2.4%,much lower than 15.6%(P<0.05)in the control.Conclusion The application of LH in the treatment of patients with intrahepatic bile duct stones is efficacious,which has less post-operational complications and less relapse of stones.

关 键 词：肝内胆管结石 腹腔镜肝切除术 经皮经肝穿刺胆道镜取石术 治疗 

分 类 号：R657.4[医药卫生—外科学]