摘要
目的:观察腹腔镜联合胆道镜下钬激光碎石术治疗肝内胆管结石患者的效果。方法:选取2020年6月至2022年1月该院收治的66例肝内胆管结石患者进行前瞻性研究,按随机数字表法将其分为对照组与观察组各33例。对照组采用传统开腹胆道镜下钬激光碎石术治疗,观察组采用腹腔镜联合胆道镜下钬激光碎石术治疗,比较两组手术相关指标水平、手术前后肝胆功能指标[天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)以及总胆汁酸(TBA)]水平、应激指标水平[白细胞介素-6(IL-6)、C-反应蛋白(CRP)]、并发症发生率。结果:两组手术时间比较,差异无统计学意义(P>0.05);观察组术中出血量少于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);术后3个月,观察组AST、TBiL水平低于对照组,TBA水平高于对照组,差异有统计学意义(P<0.05);术后5 d,两组CRP、IL-6水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为6.06%(2/33),低于对照组的24.24%(8/33),差异有统计学意义(P<0.05)。结论:腹腔镜联合胆道镜下钬激光碎石术治疗肝内胆管结石患者,可有效减轻机体应激反应,促进术后肝胆功能恢复,降低并发症发生率,其效果优于传统开腹胆道镜下钬激光碎石术治疗。
Objective:To observe effects of laparoscopic choledochoscopy combined with holmium laser lithotripsy in treatment of intrahepatic bile duct stones.Methods:66 patients with intrahepatic bile duct stones admitted to our hospital from June 2020 to January 2022 were selected for the prospective study and were divided into control group and observation group according to the random number table method,33 cases in each group.The control group was treated with traditional transabdominal choledochoscopy combined with holmium laser lithotripsy,while the observation group was treated with laparoscopic choledochoscopy combined with holmium laser lithotripsy.The levels of surgery-related indexes,the hepatobiliary function index levels[serum aspartate aminotransferase(AST),total bilirubin(TBiL),total bile acid(TBA)],the stress index levels[interleukin-6(IL-6),C-reactive protein(CRP)],and the incidence of complications were compared between the two groups before and after the treatment.Results:There was no significant difference in the operation time between the two groups(P>0.05).The intraoperative blood loss and the hospitalization time in the observation group were less than those in the control group,and the differences were statistically significant(P<0.05).3 months after the surgery,the levels of AST and TBiL in the observation group were lower than those in the control group,the level of TBA was higher than that in the control group,and the differences were statistically significant(P<0.05).5 days after the surgery,the levels of CRP and IL-6 in the two groups were higher than those before the surgery,but those of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 6.06%(2/33),which was lower than 24.24%(8/33)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Laparoscopic choledochoscopy combined with holmium laser lithotripsy in the treatment of the patients with intrahepatic bile duct stones is superior to the traditional transabdominal surgery.It can effectively reduce the body’s stress response,promote the recovery of postoperative hepatobiliary r function,and reduce the incidence of complications.
作者
郑伟雄
郑镇波
张雯娣
ZHENG Weixiong;ZHENG Zhenbo;ZHANG Wendi(General Surgery Department of Dongguan Chang’an Hospital,Dongguan 523800 Guangdong,China)
出处
《中国民康医学》
2022年第14期65-67,71,共4页
Medical Journal of Chinese People’s Health
基金
东莞市社会科技发展(一般)项目(2020507150110639)。
关键词
肝内胆管结石
腹腔镜
胆道镜
钬激光碎石术
肝胆功能
应激反应
Intrahepatic bile duct stone
Laparoscopy
Choledochoscopy
Holmium laser lithotripsy
Hepatobiliary function
Stress response
