完全腹腔镜下解剖性肝左外叶切除术在肝胆管结石治疗中的可行性和安全性分析  

The feasibility and safety analysis of complete laparoscopic anatomical left external lobectomy in the treatment of hepatobiliary stones

作　　者：洪丁山 李建国 房全党 叶剑鹏 HONG Dingshan;LI Jianguo;FANG Quandang;YE Jianpeng(Department of General Surgery,Zhangzhou Zhengxing Hospital,Zhangzhou,Fujian,363000,China)

机构地区：[1]漳州正兴医院普外科,福建漳州363000

出　　处：《当代医学》2023年第2期37-40,共4页Contemporary Medicine

摘　　要：目的探究完全腹腔镜下解剖性肝左外叶切除术在肝胆管结石治疗中的可行性和安全性。方法选取2019年1月至2021年2月本院收治的86例肝胆管结石患者作为研究对象,按照随机数字表法分为腔镜组与开腹组,各43例。开腹组行开腹手术,腔镜组行完全腹腔镜下解剖性肝左外叶切除术,比较两组手术指标、并发症发生率、应激反应[人类自然杀伤(NK)细胞、白细胞介素-6(IL-6)及C反应蛋白(CRP)]及生命质量。结果腔镜组术中出血量少于开腹组,下床时间、排气时间、住院时间均短于开腹组,手术时间长于开腹组,差异有统计学意义(P<0.05)。术前,两组NK细胞、IL-6、CRP水平比较差异无统计学意义;术后,两组NK细胞水平均低于术前,IL-6、CRP水平均高于术前,但腔镜组NK细胞水平高于开腹组,CRP、IL-6水平均低于开腹组,差异有统计学意义(P<0.05)。术前,两组生理状态、心理状态、社会活动评分比较差异无统计学意义;术后,两组生理状态、心理状态、社会活动评分均高于术前,且腔镜组高于开腹组,差异有统计学意义(P<0.05)。腔镜组并发症发生率(4.65%)低于开腹组(30.32%),差异有统计学意义(P<0.05)。结论完全腹腔镜下解剖性肝左外叶切除术治疗肝胆管结石疗效确切,应激反应少,并发症少,患者术后生命质量较高,安全可行,值得临床推广应用。Objective To explore the feasibility and safety of complete laparoscopic anatomical left external lobectomy in the treatment of hepatobiliary stones.Methods 86 patients with hepatobiliary stones admitted to our hospital from January 2019 to February 2021 were selected as the research subjects,and they were divided into endoscopic group and open abdomen group,with 43 cases in each group.The open abdomen group underwent open surgery,and the endoscopic group underwent complete laparoscopic anatomical left external lobectomy,the surgical indicators,complication rate,stress response(natural killer[NK]cells,interleukin-6[IL-6]and Creaction protein[CRP])and quality of life were compared between the two groups.Results The intraoperative bleeding amount in the endoscopic group was less than that of the open abdomen group,the implantation time,exhaust time and hospital stay were shorter than that of the open abdomen group,and the operation time was longer than that of the open abdomen group,the difference was statistically significant(P<0.05).Before operation,there was no significant difference in the levels of NK cells,IL-6 and CRP between the two groups;after operation,the levels of NK cells in the two groups were lower than those before operation,and the levels of IL-6 and CRP were higher than those before operation,but the levels of NK cells in the endoscopic group were higher than those in the open abdomen group,and the levels of CRP and IL-6 were lower than those in the open abdomen group,the differences were statistically significant(P<0.05).Before operation,there was no significant difference in physiological state,psychological state and social activity score between the two groups;after operation,the scores of physiological state,psychological state and social activity in the two groups were higher than those before operation,and the laparoscopic group was higher than the open abdomen group,the differences were statistically significant(P<0.05).The incidence of complications in the endoscopic group(4.65%)was lowe

关 键 词：完全腹腔镜解剖性肝左外叶切除术 肝胆管结石 可行性 安全性 

分 类 号：R657.4[医药卫生—外科学]