腹腔镜解剖性肝左外叶切除术治疗肝内胆管结石临床研究

Clinical study of laparoscopic anatomical left outer lobe resection for intrahepatic bile duct stones

目的探讨腹腔镜解剖性肝左外叶切陈术治疗肝内胆管结石患者的临床效果.方法将103例肝内胆管结石患者依照手术方法不同分为研究组52例,对照组51例,研究组采取腹腔镜解剖性肝左外叶切除术治疗,对照组采取开腹肝左外叶切除术治疗,术后随访3个月.统计比较两组手术及术后恢复情况、并发症发生率,手术前后检测两组血清C反应蛋白、皮质醇、白细胞介素-6、肾上腺素水平,术前及随访3个月采用生活质量评分表评定两组生活质量.结果研究组术中失血量显著少于对照组,术后下地时间、恢复饮食时间显著早于对照组,住院用时显著短于对照组(P<0.01),并发症总发生率(1.9%)显著低于对照组(15.7%)(P<0.05);研究组术后血清C反应蛋白、皮质醇、白细胞介素-6、肾上腺素水平显著低于对照组(P<0.01),随访3个月生活质量评分表评分显著高于对照组(P<0.01).结论腹腔镜解剖性肝左外叶切除术治疗肝内胆管结石临床效果显著,安全性高,能减轻患者炎性及应激反应,提高生活质量.

Objective To investigate the clinical effect of laparoscopic anatomical left outer lobe resection in the treatment of intrahepatic bile duct stones.Methods A total of 103 patients with intrahepatic bile duct stones were divided into study group(n=52)and control group(n=51)according to different surgical methods.The study group was given laparoscopic anatomical left lateral lobe resection,and the control group wastreated with open hepatic left outer lobe resection,followed up for 3 months.The operation and postoperative recovery and complication rate were compared between the two groups.Serum C-reactive protein,cortisol,interleukin-6,and epinephrine levels were measured before and after surgery.Before and after 3 months follow-up,WHOQOL-100 was used to assess the quality of life of the two groups.Results The blood loss of the study group was less than that of the control group.The time of postoperative ambulation and diet time were significantly earlier than those in the control group.The length of hospital stay was significantly shorter than that of the control group(P<0.01),and the total incidence of complications(1.9%)was significantly lower than that of the control group(15.7%)(P<0.05).Postoperative serum CRP,Cor,IL-6,E levels were lower than those of the control group(P<0.01).After follow up of 3 months,the WHOQOL 100 score was significantly higher than the control group(P<0.01).Conclusions Patients with intrahepatic bile duct stones undergo laparoscopic anatomical left lateral lobectomy.The clinical efect is clear,which can reduce inflammation and stress response,improve the quality of life,and has high safety.