腹腔镜肝叶切除术联合胆道镜治疗复杂原发性肝内外胆管结石的效果分析

Laparoscopic Lobectomy Combined with Choledochoscopy in the Treatment of Complex Primary Hepatolithiasis

目的:探讨腹腔镜肝叶切除术联合胆道镜治疗复杂原发性肝内外胆管结石的效果。方法:选取2017年5月-2019年11月80例复杂原发性肝内外胆管结石患者,按照入院ID号实施平分,每组40例。对照组患者采用传统开腹手术联合胆道镜治疗,观察组患者采用腹腔镜肝叶切除术联合胆道镜治疗,比较两组血清生化指标、围术期基本指标及术后并发症情况。结果:术后7 d两组患者的ALT指标及CA199指标均下降,且观察组ALT指标及CA199指标下降幅度更大,两组Cor指标升高,但观察组Cor指标低于对照组(P<0.05);与对照组比较,观察组患者手术用时长,但术中出血量更少,肛门排气时间更早,引流时间更短(P<0.05);观察组胆漏2例、胆道出血2例、肠梗阻1例,并发症发生率为12.50%,对照组胆漏2例、胆道出血2例、切口感染5例、肠梗阻4例,并发症发生率32.50%,观察组并发症发生率低于对照组(P<0.05)。结论:针对复杂原发性肝内外胆管结石患者,采用腹腔镜肝叶切除术联合胆道镜治疗术中出血量少,肛门排气快,引流时间短且并发症少,安全性及疗效突出,有利于术后恢复。

Objective:To investigate the effect of laparoscopic lobectomy combined with choledochoscopy in the treatment of complex primary intrahepatic and extrahepatic cholelithiasis.Method:A total of 80 patients with complicated primary intrahepatic and extrahepatic cholelithiasis were selected.From May 2017 to November 2019,they were divided equally according to the ID number of admission,40 patients in each group.The patients in the control group were treated with traditional laparotomy combined with choledochoscopy.The patients in the observation group were treated with laparoscopic lobectomy combined with choledochoscopy.The serum biochemical indexes,perioperative basic indexes and postoperative complications were compared.Result:The ALT index and CA199 index of the two groups decreased at 7 days after operation,and the ALT index and CA199 index of the observation group decreased more,the Cor index of the two groups increased,but the Cor index of the observation group was lower than that of the control group(P<0.05).In the observation group,there were 2 cases of bile leakage,2 cases of biliary hemorrhage and 1 case of intestinal obstruction,the incidence of complications was 12.50%.In the control group,there were 2 cases of bile leakage,2 cases of biliary hemorrhage,5 cases of incision infection and 4 cases of intestinal obstruction,the incidence of complications was 32.50%.The incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion:For patients with complicated primary intrahepatic and extrahepatic cholelithiasis,laparoscopic hepatectomy combined with choledochoscopy is helpful for postoperative recovery.