腹腔镜引导肝叶切除+胆道镜取石对肝内胆管结石患者肝胆功能、应激指标及并发症的影响  

Effect of Laparoscopy-guided Hepatectomy Plus Choledochoscopic Lithotomy on Hepatobiliar y Function,Stress Index and Complications in Patients with Intrahepatic Bile Duct Stones

作　　者：张生建 危国庆 黄会华 Zhang Sheng-jian;Wei Guo-qing;Huang Hui-hua(Department of General Surgery,Shaowu Municipal Hospital,Nanping 354000,Fujian Province,China)

机构地区：[1]邵武市立医院普外科,福建南平354000

出　　处：《罕少疾病杂志》2023年第6期46-47,55,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的探析肝内胆管结石患者采取腹腔镜引导肝叶切除与胆道镜取石联合治疗对并发症、应激指标、肝胆功能的影响。方法选取我院2019年1月至2021年12月收治的80例肝内胆管结石患者,根据双盲法均分,人数40例/组。所有患者均接受腹腔镜引导肝叶切除手术,对照组加之肝实质胆管切除取石术,观察组加之胆道镜取石术,比对两组肝胆功能、应激指标以及并发症发生率等指标。结果观察组手术治疗时长较对照组更短,术后出血量较对照组更少,结石清除率较对照组更高(P<0.05),术后观察组肝胆功能指标包括GGT(85.12±26.32)U/L、ALT(45.56±10.92)U/L、ALP(104.68±24.32)U/L水平低于对照组,组间比较差异显著(P<0.05),两组术前应激指标水平比对无差异(P>0.05),与术后对照组比较,观察组肾上腺素(119.65±12.03)ng/mL、皮质醇(188.62±24.65)nmol/L水平均更低(P<0.05);观察组并发症发生率5.00%相比于对照组22.50%低,差异显著(P<0.05)。结论对于肝内胆管结石患者,给予腹腔镜引导肝叶切除与胆道镜取石联合治疗,肝胆功能明显改善,应激反应更低,并发症更少,安全可靠,值得临床推广借鉴。Objective To explore the effect of laparoscopic guided hepatectomy combined with choledochoscopic lithotomy on complications,stress index and hepatobiliary function in patients with intrahepatic bile duct stones.Methods A total of 80 patients with intrahepatic bile duct stones admitted to our hospital from January 2019 to December 2021 were selected and divided into 40 cases/group according to the double-blind method.All patients underwent laparoscopically guided liver lobectomy,Hepatobiliary function,stress index and incidence of complications were compared between the two groups.Results The operation duration of the observation group was shorter than that of the control group,the postoperative blood loss was less than that of the control group,and the stone clearance rate was higher than that of the control group(P<0.05).The levels of GGT(85.12±26.32)U/L,ALT(45.56±10.92)U/L and ALP(104.68±24.32)U/L in the observation group were lower than those in the control group,and the differences between the two groups were significant(P<0.05).Compared with the postoperative control group,the levels of epinephrine(119.65±12.03)ng/mL and cortisol(188.62±24.65)nmol/L in the observation group were lower(P<0.05).The complication rate of the observation group was 5.00%lower than that of the control group 22.50%,and the difference was significant(P<0.05).Conclusion For patients with intrahepatic bile duct stones,laparoscopic guided hepatectomy combined with choledochoscopic lithotomy can significantly improve the hepatobiliary function,reduce stress response,and reduce complications,which is safe and reliable,and worthy of clinical promotion.

关 键 词：肝内胆管结石 腹腔镜引导肝叶切除 胆道镜取石 肝胆功能 应激反应 

分 类 号：R364.25[医药卫生—病理学]