腹腔镜胆道探查取石术对肝内外胆管结石患者结石残留率及复发率的影响  

Effects of laparoscopic biliary exploration and lithotripsy on residual rate and recurrence rate of stones in patients with intrahepatic and extrahepatic bile duct stones

作　　者：冯海军 王海荣 刘勇峰[3] FENG Haijun;WANG Hairong;LIU Yongfeng(General Surgery Department,the People's Hospital of Yanchuan County,Yan'an 717200;General Surgery Department,the People's Hospital of Wuqi County,Yan'an 717600;General Surgery Department,Yan'an University Affiliated Hospital,Yan'an 716000,China)

机构地区：[1]延川县人民医院普外科,陕西延安717200 [2]吴起县人民医院普外科,陕西延安717600 [3]延安大学附属医院普外科,陕西延安716000

出　　处：《临床医学研究与实践》2023年第29期65-68,共4页Clinical Research and Practice

摘　　要：目的探讨腹腔镜胆道探查取石术对肝内外胆管结石患者结石残留率及复发率的影响。方法选择2020年1月至12月收治的60例肝内外胆管结石患者,依据入院编号的奇偶性将其分为对照组与观察组,各30例。对照组实施腹腔镜下胆管切开取石术,观察组实施腹腔镜胆道探查取石术。比较两组的治疗效果。结果两组的治疗总有效率、结石复发率及残留率比较,差异无统计学意义(P>0.05)。观察组的手术时间、住院时间、肛门排气时间短于对照组,手术出血量、腹腔引流量少于对照组(P<0.05)。术后7 d,观察组的总胆红素(TBIL)、总胆汁酸(TBA)、结合胆红素(CB)、非结合胆红素(UCB)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)水平低于对照组(P<0.05)。术后1 d,观察组的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平低于对照组,白细胞介素-10(IL-10)水平高于对照组(P<0.05)。结论腹腔镜胆道探查取石术与腹腔镜下胆管切开取石术治疗肝内外胆管结石患者的效果、结石残留率及复发率无差异,但前者可显著降低机体损伤,减轻炎症反应,有助于促进肝胆功能的恢复。Objective To explore the effects of laparoscopic biliary exploration and lithotripsy on residual rate and recurrence rate of stones in patients with intrahepatic and extrahepatic bile duct stones.Methods Sixty patients with intrahepatic and extrahepatic bile duct stones admitted from January to December 2020 were selected and divided into control group and observation group according to the parity of admission number,with 30 cases in each group.The control group was treated with laparoscopic cholangiolithotomy,and the observation group was treated with laparoscopic biliary exploration and lithotripsy.The therapeutic effects of the two groups were compared.Results There were no significant differences in the total effective rate of treatment,stone recurrence rate and residual rate between the two groups(P>0.05).The operation time,hospitalization time and anal exhaust time of the observation group were shorter than those of the control group,and the amount of bleeding and abdominal drainage were less than those of the control group(P<0.05).At 7 d after operation,the levels of total bilirubin(TBIL),total bile acid(TBA),conjugated bilirubin(CB),unconjugated bilirubin(UCB),aspartate aminotransferase(AST),alkaline phosphatase(ALP)andγ-glutamyl transferase(GGT)in the observation group were lower than those in the control group(P<0.05).At 1 d after operation,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)in the observation group were lower than those in the control group,and the level of interleukin-10(IL-10)was higher than that in the control group(P<0.05).Conclusion There are no differences in the effect,stone residual rate and recurrence rate between laparoscopic biliary exploration and lithotripsy and laparoscopic cholangiolithotomy in the treatment of patients with intrahepatic and extrahepatic bile duct stones,but the former can significantly reduce the body damage,alleviate inflammatory response,and help to promote the recovery of hepatobiliary function.

关 键 词：肝内外胆管结石 腹腔镜胆道探查取石术 腹腔镜下胆管切开取石术 肝胆功能 

分 类 号：R657.42[医药卫生—外科学]