经皮肝胆道造瘘碎石取石术在肝胆管结石患者中的应用价值

The value of percutaneous hepatobiliary lithotripsy application in patients with hepatolithiasis

目的:探讨经皮肝胆道造瘘碎石取石术在肝胆管结石患者中的应用价值。方法:选取2016年6月至2018年6月广西梧州市人民医院普外科收治的88例肝胆管结石患者为研究对象,按随机数字表法将患者分为对照组和观察组,每组44例,其中对照组行腹腔镜胆总管切开取石术,观察组行经皮肝胆道造瘘碎石取石术。比较两组手术时间、术中出血量、术后排气时间、住院时间的差异,分析两组患者术前及术后7 d总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)及T淋巴细胞亚群(CD3^+T、CD4^+T、CD8^+T百分比及CD4^+T/CD8^+T比值)变化情况,并观察两组患者结石一次取尽率、术后并发症发生率及随访结果。结果:观察组术中出血量显著低于对照组(P<0.05);术后排气时间、住院时间显著短于对照组(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05)。两组患者术后7 d肝功能指标TBIL、ALT、AST、GGT、ALP及免疫功能指标CD3^+、CD4^+、CD4^+/CD8^+均显著低于术前(均P<0.05);但两组术后之间比较,差异均无统计学意义(均P>0.05)。观察组结石一次取尽率、术后并发症发生率、术后随访1年肝胆管结石复发率分别为77.27%、4.55%、0.00%,对照组依次为72.73%、9.09%、2.27%,两组比较差异均无统计学意义(均P>0.05)。结论:经皮肝胆道造瘘碎石取石术与腹腔镜胆总管切开取石术治疗肝胆管结石均安全、有效,对患者肝功能及免疫功能的影响均较小,但前者住院时间短、术后恢复快。

Objective:To study the value of percutaneous hepatobiliary lithotripsy application in patients with hepatolithiasis.Methods:A total of 88 patients with hepatolithiasis admitted to our hospital from June 2016 to June 2018 were divided into an observation group and a control group,with 44 cases in each group.The patients in the control group underwent laparoscopic choledocholithotomy,while those in the observation group underwent percutaneous hepatolithotomy.The operation time,intraoperative bleeding volume,postoperative exhaust time,hospital days,the levels of total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyltransferase(GGT),alkaline phosphatase(ALP)and T lymphocyte subsets(CD3^+T,CD4^+T,CD8^+T percentage and CD4^+T/CD8+T ratio)before and 7 days after operation as well as one-time stone removal rate,incidence of complications were compared.Results:The bleeding volume during operation,the time of exhaust,recovery time of gastrointestinal function and hospital days after operation in the observation group were significantly lower than those in the control group(P<0.05),but there was no significant difference in the operation time between groups(P>0.05).The liver function indexes such as TBIL,ALT,AST,GGT,ALP and immune function indexes such as CD3^+,CD4^+and CD4^+/CD8^+in the two groups were significantly decreased after operation(P<0.05),but no significant difference was found between two groups(P>0.05).The stone removal rate,complications incidence and recurrence rate of hepatolithiasis in the observation group were 77.27%,4.55%and 0.00%,respectively,and those in the control group were respectively 72.73%,9.09%and 2.27%(P>0.05).Conclusion:Both percutaneous hepatobiliary lithotripsy and laparoscopic choledocholithotomy are safe and effective in the treatment of hepatobiliary calculi,and have little influence on the liver function and immune function of patients,but the former can reduce hospital days and promote the recovery of patients after operation.