输尿管硬镜下结石清除术治疗肝胆管难取性结石效果探讨  

Effect of ureteroscopic stone removal surgery for difficult to remove hepatobiliary stones

作　　者：王锦锰 孟健 WANG Jinmeng;MENG Jian(Department of General Surgery,Yicheng District People's Hospital,Zaozhuang,Shandong 277300,China)

机构地区：[1]枣庄市峄城区人民医院普外科,山东枣庄277300

出　　处：《社区医学杂志》2023年第24期1277-1281,共5页Journal Of Community Medicine

摘　　要：目的探讨肝胆管难取性结石治疗中输尿管硬镜的临床应用价值。方法选取2020-02-15-2022-02-15枣庄市峄城区人民医院收治的60例肝胆管难取性结石患者为研究对象,依据手术方法分为经皮输尿管硬镜下结石清除术组(输尿管硬镜组)、纤维胆管镜下常规性开腹切开胆管取石术组(胆管镜组),各30例。分析2组净石、残石、再次手术情况,以及围术期指标、结石数目、疼痛程度、心理应激、生活质量、生理应激、肝胆功能、临床疗效、术后并发症发生情况。结果2组患者的净石率、残石率、再次手术率比较,差异无统计学意义,均P>0.05。输尿管硬镜组患者术中出血量为(80.75±11.76)mL,少于胆管镜组的(140.88±23.73)mL,t=12.436,P<0.001;肠功能恢复时间、住院时间分别为(1.98±0.34)、(7.64±1.51)d,短于胆管镜组的(3.77±0.72)、(11.98±2.87)d,t值分别为12.313和7.330,均P<0.001。输尿管硬镜组患者结石数目少于胆管镜组,视觉模拟评分(VAS)、焦虑评分、抑郁评分均低于胆管镜组,生活质量评分高于胆管镜组,血糖(GLU)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、C反应蛋白(CRP)、白介素-6(IL-6)、可溶性肿瘤坏死因子受体(sTNFR)、直接胆红素(DBIL)、总胆红素(TBIL)、碱性磷酸酶(AKP)、天冬酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(γ-GT)水平均低于胆管镜组,均P<0.001。输尿管硬镜组患者总有效率为96.67%(29/30),高于胆管镜组的73.33%(22/30),χ^(2)=4.706,P=0.030。输尿管硬镜组患者的术后并发症发生率为6.67%(2/30),低于胆管镜组的26.67%(8/30),χ^(2)=4.320,P=0.038。结论肝胆管难取性结石治疗中经皮输尿管硬镜下结石清除术的临床价值较纤维胆管镜下常规性开腹切开胆管取石术高。Objective To explore the clinical application value of ureteroscopy in the treatment of difficult to remove hepatobiliary stones.Methods Totally 60 patients with refractory hepatobiliary calculi admitted to Yicheng District People's Hospital of Zaozhuang City from February 15,2020 to February 15,2022 were selected as the research objects.According to the surgical methods,they were divided into two groups:percutaneous ureteroscopic stone removal group(ureteroscopic group)and conventional open choledochoscopy group(choledochoscopy group),with 30 cases in each group.The status of stone removal,residual stone removal,and reoperation,perioperative indicators,number of stones,degree of pain,psychological stress,quality of life,physiological stress,liver and gallbladder function,clinical efficacy,and postoperative complications of the two groups were analyzed.Results There were no statistically significant differences in the net stone rates,residual stone rates,and reoperation rates between the two groups of patients,all P>0.05.The intraoperative blood loss in the ureteroscopic group was(80.75±11.76)ml,which was lower than that in the choledochoscopy group(140.88±23.73)ml,t=12.436,P<0.001);The recovery time of intestinal function and hospitalization time were(1.98±0.34)and(7.64±1.51)days,respectively,which were shorter than the(3.77±0.72)and(11.98±2.87)days in the choledochoscopy group.The t-values were 12.313 and 7.330,respectively,with all P<0.001.The number of stones in the rigid ureteroscope group was less than that in the choledochoscope group,the visual analogue score(VAS),anxiety score,depression score were lower than that in the choledochoscope group,and the quality of life score was higher than that in the choledochoscope group.The levels of blood glucose(GLU),cortisol(Cor),adrenocorticotropic hormone(ACTH),C-reactive protein(CRP),interleukin-6(IL-6),soluble tumor necrosis factor receptor(sTNFR),direct bilirubin(DBIL),total bilirubin(TBIL)alkaline phosphatase(AKP),aspartate aminotransferase(AST),alanine a

关 键 词：肝胆管难取性结石 常规性开腹切开胆管取石术 输尿管硬镜下结石清除术 净石 残石 再次手术 并发症 

分 类 号：R657.4[医药卫生—外科学]