腹腔镜胆道镜双镜联合钬激光治疗复杂性肝胆管结石的效果

Effect of Laparoscopic Choledochoscopy Combined with Holmium Laser in the Treatment of Complex Hepatolithiasis

目的分析腹腔镜胆道镜双镜联合钬激光治疗复杂性肝胆管结石的效果.方法选取淮安市肿瘤医院2020年2月—2023年2月收治的78例复杂性肝胆管结石患者为研究对象,随机将其分为研究组和对照组,每组39例.对照组采用腹腔镜胆道镜双镜联合液电碎石术治疗,研究组采用腹腔镜胆道镜双镜联合钬激光术治疗.对比两组患者的围术期情况﹑肝功能水平﹑氧化应激反应水平﹑并发症发生情况﹑残余结石率及复发率.结果研究组的操作时间﹑术后排气时间﹑住院天数均短于对照组,出血量少于对照组,组间差异有统计学意义(P<0.05).术后7 d,研究组的谷丙转氨酶﹑谷草转氨酶﹑总胆红素水平均低于对照组,组间差异有统计学意义(P<0.05).术后7 d,研究组的丙二醛水平低于对照组,谷胱甘肽过氧化物酶﹑超氧化物歧化酶水平均高于对照组,组间差异有统计学意义(P<0.05).研究组的并发症发生率为5.13%,低于对照组的20.51%,差异有统计学意义(P<0.05).研究组的结石残留率﹑复发率分别为7.69%﹑5.13%,均低于对照组的28.21%﹑25.64%,组间差异有统计学意义(P<0.05).结论采用腹腔镜胆道镜双镜联合钬激光治疗复杂性肝胆管结石患者可缩短操作时间,减少出血量,促进肝功能恢复,减轻氧化应激反应,减少并发症,加快患者术后恢复,减少结石残留及复发风险.

Objective To analyze the effect of laparoscopic choledochoscopy combined with holmium laser in the treatment of complex hepatolithiasis.Methods 78 patients with complex hepatolithiasis admitted to Huai'an Cancer Hospital from February 2020 to February 2023 were selected as the study objects and randomly divided into a study group and a control group,with 39 cases in each group.The control group was treated with laparoscopic choledochoscopy combined with electro-hydraulic lithotripsy,and the study group was treated with laparoscopic choledochoscopy combined with holmium laser.The perioperative situation,liver function levels,oxidative stress reaction levels,complications,residual stone rate and recurrence rate were compared between the two groups.Results The operation time,postoperative exhaust time and hospitalization days of the study group were shorter than those of the control group,and the blood loss was less than that of the control group,the differences between the groups were statistically significant(P<0.05).7 days after operation,the levels of alanine aminotransferase,aspartate aminotransferase and total bilirubin in the study group were lower than those in the control group,the differences between the groups were statistically significant(P<0.05).7 days after operation,the level of malondialdehyde in the study group was lower than that in the control group,and the levels of glutathione peroxidase and superoxide dismutase were higher than those in the control group,the differences between the groups were statistically significant(P<0.05).The complication rate of the study group was 5.13%,which was lower than 20.51%of the control group,the difference was statistically significant(P<0.05).The residual rate and recurrence rate of stone in the study group were 7.69%and 5.13%,respectively,which were lower than 28.21%and 25.64%in the control group,and the differences between the groups were statistically significant(P<0.05).Conclusion The use of laparoscopic choledochoscopy combined with holmium laser in the treatment of complex hepatolithiasis can shorten the operation time,reduce the amount of blood loss,promote the recovery of liver function,reduce the oxidative stress reaction,reduce complications,accelerate the postoperative recovery of patients,and reduce the risk of stone residual and recurrence.