腹腔镜下联合胆道镜、术中超声及液电碎石仪治疗复杂肝内胆管结石的效果  

Effect of laparoscopic combined with choledochoscope,intraoperative ultrasound and electro-hydraulic lithotripsy in the treatment of complex intrahepatic bile duct stones

作　　者：叶国华 姜继豪[1] 王小方[1] YE Guohua;JIANG Jihao;WANG Xiaofang(Department of Hepatobiliary and Pancreatic Surgery,Pingxiang People's Hospital,Jiangxi Province,Pingxiang337000,China)

机构地区：[1]江西省萍乡市人民医院肝胆胰外科,江西萍乡337000

出　　处：《中国当代医药》2024年第31期20-23,共4页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202311700)。

摘　　要：目的探讨腹腔镜下联合胆道镜、术中超声及液电碎石仪治疗复杂肝内胆管结石的应用价值。方法选取2023年1月至2024年3月就诊于萍乡市人民医院的60例复杂肝内胆管结石(可同时合并有肝外结石)患者为研究对象,按照随机数字表法分为对照组(n=30)和试验组(n=30)。试验组行腹腔镜下联合胆道镜、术中超声及液电碎石仪手术治疗,对照组行腹腔镜下联合胆道镜手术治疗。比较两组患者的围手术期指标(术中出血量、手术时间、胃肠功能恢复时间、术后住院时间、拔管时间)、肝功能[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]、并发症发生率和残石率。结果试验组的残石率低于对照组,差异有统计学意义(P<0.05)。试验组的术中出血量少于对照组,手术时间、胃肠功能恢复时间、术后住院时间、拔管时间短于对照组,差异有统计学意义(P<0.05)。术前两组患者的AST和ALT水平比较,差异无统计学意义(P>0.05),试验组术后的AST和ALT水平低于对照组,差异有统计学意义(P<0.05)。试验组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜下联合胆道镜、术中超声及液电碎石仪治疗复杂肝内胆管结石可减少手术并发症,降低胆管残石率,缩短患者术后住院时间,安全性较高,值得临床推广。Objective To investigate the application value of laparoscopy combined with choledochoscope,intraoperative ultrasound and electro-hydraulic lithotripsy in the treatment of complex intrahepatic bile duct stones.Methods Sixty patients with complex intrahepatic biliary calculi(which may be combined with extrahepatic calculi)admitted to the Pingxiang People's Hospital from January 2023 to March 2024 were selected as the study objects,and were divided into control group(n=30)and experimental group(n=30)according to random number table method.The experimental group underwent laparoscopic combined choledochoscopy,intraoperative ultrasound and electro-hydraulic lithotripsy,and the control group underwent laparoscopic combined choledochoscopy.The perioperative indexes(intraoperative blood loss,operation time,gastrointestinal function recovery time,postoperative hospitalization time,extubation time),liver function(aspartate transaminase[AST]and alanine transaminase[ALT]),incidence of complications and residual stone rate were compared between the two groups.Results The residual stone rate of experimental group was lower than that of control group,and the difference was statistically significant(P<0.05).The amount of blood loss during operation in experimental group was less than that in control group,and the operation time,gastrointestinal function recovery time,postoperative hospitalization time and extubation time were shorter than that in control group,and the differences were statistically significant(P<0.05).There were no significant differences in AST and ALT levels between the two groups before surgery(P>0.05),and the AST and ALT levels in the experimental group were lower than those in the control group after surgery,and the differences were statistically significant(P<0.05).The total complication rate of experimental group was lower than that of control group,and the difference was statistically significant(P<0.05).Conclusion Laparoscopy combined with choledochoscopy,intraoperative ultrasound and electro-hydraulic

关 键 词：复杂肝内胆管结石 术中超声 胆道镜 液电碎石仪 腹腔镜 

分 类 号：R575[医药卫生—消化系统]