肝叶切除术治疗肝胆管结石合并胆管狭窄患者的疗效及对机体应激反应的影响

Therapeutic efficacy of liver lobectomy in treating patients with hepatolithiasis complicated with biliary stricture and its effect on their stress response

目的探讨肝叶切除术治疗肝胆管结石合并胆管狭窄的疗效及对机体应激反应的影响。方法149例肝胆管结石合并胆管狭窄患者分为对照组(n=70)和观察组(n=79),对照组采用胆道探查取石联合T管引流术及纤维胆道镜治疗,观察组采用肝叶切除术治疗;比较2组患者的临床疗效,检测2组患者治疗前和术后第7天的血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、碱性磷酸酶(ALP)及肾上腺素(EP)、皮质醇(CO)、自然杀伤细胞(NK)、白介素-6(IL-6)、C反应蛋白(CRP)水平,比较2组患者的术后并发症、1年残石率及复发率。结果观察组患者治疗优良率高于对照组,差异有统计学意义(P<0.05);术后第7天时,2组患者血清ALP、AST、TBIL及ALT水平低于治疗前(P<0.05),观察组降低更明显,与对照组比较,差异有统计学意义(P<0.05);术后第7天,2组患者血清EP、CO、NK、IL-6及CRP水平均高于治疗前,但观察组低于对照组(P<0.05);观察组并发症发生率、1年残石率及复发率均低于对照组,差异有统计学意义(P<0.05)。结论肝叶切除术治疗肝胆管结石合并胆管狭窄的疗效优于胆道探查取石联合T管引流术及纤维胆道镜治疗,可改善患者肝功能和降低应激水平,减少并发症发生率、残石率及复发率。

Objective To investigate the therapeutic effect of lobectomy in treating patients with hepatolithiasis complicated with biliary stricture and its effect on their stress response.Methods A total of 149 patients with hepatolithiasis complicated with biliary stricture were divided into control group(n=70)and observation group(n=79).Control group was treated with choledocholithotomy plus T tube drainage and choledochoscopy,while observation group was given with liver lobectomy.The therapeutic efficacy of the two groups was compared.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),and alkaline phosphatase(ALP),and adrenaline(EP),cortisol(CO),natural killer cell(NK),interleukin-6(IL-6),and C-reactive protein(CRP)were measured before the treatment and on 7 th day after surgery.The postoperative complication rates,1-year residual stone rates and recurrence rates were compared between two groups.Results The good rates of treatment in observation group was higher than that in control group(P<0.05).On the 7 th day of treatment,the levels of serum ALP,AST,TBIL,and ALT of the two groups were lower than before treatment(P<0.05),and their levels in observation group were less than control group(P<0.05).After the treatment,the levels of serum EP,CO,NK,IL-6,and CRP in two groups were increased relative to before treatment.After the treatment,observation group had lower serum EP,CO,NK,IL-6,and CRP than control group(P<0.05).The complication rate,1-year residual stone rate,and recurrence rate in observation group were lower than those in control group(P<0.05).Conclusion Liver lobectomy is better than choledocholithotomy plus T tube drainage and choledochoscopy in treating patients with hepatolithiasis complicated with biliary stricture.It can improve liver function,decrease stress,and reduce the rates of complication incidence and residual stones and recurrence.