胆道镜2μm激光治疗肝内胆管结石并发肝功能不全七例报告

Clinical application of 2-μm laser treatment under choledochoscope for patients with hepatolithiasis and hepatic inadequacy

目的分析胆道镜2μm激光治疗肝内胆管结石并发肝功能不全的原因及预防。方法总结2010年至2014年采用腹腔镜下胆道镜联合2μm激光碎石治疗肝内胆管结石42例,分析严重手术并发症的发生原因。SPSS17.0软件进行统计学分析,患者手术时间、碎石时间、肝功和白细胞指标等,采用均数±标准差（x珋±s）表示,t检验;术前结石大小、单/多发例数、进行χ2检验,P〈0.05为差异有统计学意义。结果 42例患者中35例患者碎石成功1周内出院,7例患者术后4~5 h内发生肝功能不全,1例抢救无效死亡。回顾性分析所有病例,发现发生肝功不全的患者均ALT高于正常值3倍以上。肝功正常组在手术时间、碎石时间和结石大小方面优于肝功异常组,（45.21±12.3）min与（97.5±19.1）min,（12.3±1.60）min与（43.1±11.4）min,（1.33±0.27）cm与（4.49±1.43）cm,差异有统计学意义（χ2=0.096,0.084,0.890,P〈0.05）。结论结石大或多发结石导致碎石时间长（〉1 h）是肝功能不全的主要原因。

Objective To investigate the causes and prevention of hepatolithiasis and hepatic insufficiency by using 2-μm laser treatment under a eholedochoseope. Methods 42 patients with hepatofithiasis and hepatic insufficiency underwent 2-μm laser lithotripsy under laparoscope and choledochoscope from 2010 to 2014 in our hospital. The causes of the complications were analyzed using SPSS17.0 software. Operation time, gravel time, indicators of liver function and white blood cells were expressed as mean _＋ standard deviation, and the results were compared by Student＇s t test. Preoperative stone size, and single / multiple stones were compared by the chi-square test and P 〈 0. 05 was considered statistically significant. Results 35 patients were successfully cured and discharged within a week. Hepatic failure occurred in 7 patients within 4 - 5 hours after operation, and one of them died. The operation time, and gravel time stone size in patients with normal liver function were superior to those in patients with abnormal liver function （P 〈 0. 05 ）. Retrospective analysis of all patients revealed that the ALT level of all 7 patients with hepatic insufficiency was 3 times higher than the normal value. In these patients [ 2 patients with large stones （ 〉 2 cm）, 5 with multiple stones ~, lithotripsy time exceeded one hour. Conclusion The main causes of hepatic insufficiency are large volume of stones and longer operation time due to multiple stones （ 〉 1 h）.