熊去氧胆酸在腹腔镜下胆道镜联合钬激光治疗肝内外胆管结石的疗效观察

(1.Chuzhou People’s Hospital General Surgery 571700;2.The Third People’s Hospital of Hainan Province General Surgery 572000) [Foundation Project]: This is supported by the Hainan Province and Family Planning Industry Research Project (No. 19A200054) [Autho

目的:探究熊去氧胆酸在腹腔镜下胆道镜联合钬激光治疗肝内外胆管结石的疗效观察。方法:选取本院外科收治的84例肝内外胆管结石患者作为研究对象,随机分为对照组和观察组(n=42)。对照组腹腔镜下行纤维胆道镜联合钬激光碎石治疗,观察组在对照组基础上再给予熊去氧胆酸治疗。比较治疗前,治疗3个月、6个月两组临床疗效,肝功能、胆汁相关指标总胆汁酸(TBA)、磷脂(PLIP)、胆固醇(CHO)水平,及并发症发生情况,同时随访1年,记录肝胆结石复发及复发后再次手术情况。结果:治疗3个月后观察组治愈22例,显效11例,有效5例,其临床疗效优于对照组(P<0.05)。治疗3个月、6个月后,两组AST、ALT、TBil、CHO水平较治疗前均有下降,TBA、PLIP水平上升,且观察组肝胆功能改善情况明显优于对照组,差异均具有统计学意义(P<0.05)。观察组中出现右上腹疼痛、黄疸、寒战发热等症状较对照组好转,且恶心呕吐、乏力等并发症发生率明显低于对照组(P<0.05)。随访1年发现观察组复发后再次手术率低于对照组,差异有统计学意义(P<0.05)。结论:熊去氧胆酸联合胆道镜联合钬激光治疗临床疗效显著,可有效改善不良并发症降低术后复发率及再次手术率,其主要原因可能是联合治疗提高了患者TBA、PLIP水平,降低AST、ALT、TB il及CHO水平,有助于改善肝胆功能,减少胆汁淤积,防止肝胆结石复发,促进良好预后。

Objective:To investigate the effect of clinical ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy in the treatment of intrahepatic and intrahepatic bile duct stones.Methods:Patients with intrahepatic and intrahepatic bile duct stones treated by surgery in our hospital from October 2017 to December 2018 were randomly divided into control group and observation group.Patients in the control group were treated with laparoscopic choledochoscopy combined with holmium laser lithotripsy,and patients of the observation group were treated with ursodeoxycholic acid on the basis of the control group.The clinical efficacy,total bile acid(TBA),phospholipid(PLIP),cholesterol(CHO)levels and the incidence of complications of liver function and bile related indicators were compared between the two groups after 3 and 6 months treatment.Results:After 3 months treatment,there were 22 cases of cured patients,11 cases of markedly effective and 5 cases of effective patients in the observation group of,which he clinical curative effect was significantly better than that of control group(P<0.05).After3 months and 6 months treatment,AST,ALT,TBil,CHO levels in two groups were decreased compared with that before treatment,and TBA,PLIP levels were increased.The liver functionofpatientsintheobservation group was obviously better than that in the control group with the statistical significance difference(P<0.05).However,the symptoms such as the right upper quadrant pain,jaundice,chills,fever in the observation group was significantly improvedthanthat of the control group.The incidence of complications including nausea and vomiting,fatiguewas 4.76%,significantly lower than that 19.05%in the control group(P<0.05).After 1 year follow-up,it was found that recurrence reoperation rate of observation group was significantly lower than that the control group.The difference was statistically significant(P<0.05).Conclusion:Theclinical curative effect of the ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy was distinct,whichcould effectively improve the undesirable complications,reduce the postoperative recurrence and reoperation rate.Themain reason may be the combination therapy could improve the patients'associates,PLIP level,lower levels of AST,ALT,TB il and CHO,which helped to improve liver function,reduce the cholestasis,prevent the recurrence of liver and gallbladder stones,and promote good prognosis.