胆道镜钬激光碎石术联合肝叶切除术对复杂性肝内胆管结石患者结石清除率、生化指标及生活质量的影响  

Effect of choledochoscopy holmium laser lithotripsy combined with hepatectomy on stone clearance rate,biochemical indexes and quality of life in patients with complex intrahepatic bile duct stones

作　　者：陈罗飞 李晓春 晁旭[2] 梁民 徐子忠 CHEN Luofei;LI Xiaochun;CHAO Xu;LIANG Min;XU Zizhong(the First People's Hospital of Xianyang,Xianyang 712000;the Second Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]咸阳市第一人民医院,陕西咸阳712000 [2]陕西中医药大学第二附属医院,陕西咸阳712000

出　　处：《临床医学研究与实践》2023年第19期64-67,共4页Clinical Research and Practice

基　　金：陕西中医药大学第二附属医院学科创新团队建设项目(No.2020XKTD-A01)。

摘　　要：目的探讨胆道镜钬激光碎石术联合肝叶切除术对复杂性肝内胆管结石患者结石清除率、生化指标及生活质量的影响。方法选取2019年5月至2021年5月我院接收的150例复杂性肝内胆管结石患者为研究对象,根据治疗方案不同将其分为对照组和观察组,各75例。对照组给予胆总管切开取石术+肝叶切除术治疗,观察组给予胆道镜钬激光碎石术+肝叶切除术治疗。比较两组的治疗效果。结果观察组的手术时间、胃肠功能恢复时间及住院时间短于对照组,术中出血量少于对照组,结石清除率高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。术后5 d,两组的总胆红素、谷丙转氨酶、天门冬氨酸氨基转氨酶、碱性磷酸酶及谷氨酰基转移酶水平均降低,且观察组低于对照组(P<0.05)。术后3个月,观察组的健康调查简表(SF-36)各维度评分均高于对照组(P<0.05)。结论胆道镜钬激光碎石术联合肝叶切除术治疗复杂性肝内胆管结石效果较好,可提高结石清除率,缩短住院时间,降低并发症发生率,改善生化指标水平,提高生活质量。Objective To explore the effect of choledochoscopy holmium laser lithotripsy combined with hepatectomy on stone clearance rate,biochemical indexes and quality of life in patients with complex intrahepatic bile duct stones.Methods A total of 150 patients with complex intrahepatic bile duct stones received in our hospital from May 2019 to May 2021 were selected as the research objects.According to different treatment schemes,the patients were divided into control group and observation group,with 75 cases in each group.The control group was treated with choledocholithotomy+hepatectomy,and the observation group was treated with choledochoscopy holmium laser lithotripsy+hepatectomy.The therapeutic effects of the two groups were compared.Results The operation time,gastrointestinal function recovery time and hospitalization time of the observation group were shorter than those of the control group,the intraoperative 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 total incidence of complications in the observation group was lower than that in the control group(P<0.05).At 5 d after operation,the levels of total bilirubin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase and glutamine transferase in the two groups decreased,and those in the observation group were lower than the control group(P<0.05).At 3 months after operation,the scores of each dimension of the MOS 36-Item Short Form Health Survey(SF-36)in the observation group were higher than those in the control group(P<0.05).Conclusion Choledochoscopic holmium laser lithotripsy combined with hepatectomy is effective in the treatment of complex intrahepatic bile duct stones,which can improve the stone clearance rate,shorten the hospitalization time,reduce the incidence of complications,improve the biochemical indexes levels and quality of life.

关 键 词：胆道镜钬激光碎石术 肝叶切除术 复杂性肝内胆管结石 

分 类 号：R657.4[医药卫生—外科学]