腔镜下小范围切肝结合胆道扩张支撑术治疗左肝内外胆管结石伴胆管炎的效果及对应激反应、肝胆功能的影响

Effect of small range hepatectomy under laparoscopic combined with biliary tract dilatation support in the treatment of left intrahepatic and extrahepatic bile duct stone complicated with cholangitis and its influences on stress reaction and hepatobiliary

目的探讨腔镜下小范围切肝结合胆道扩张支撑术治疗左肝内外胆管结石伴胆管炎的效果,以为临床手术方式的选择提供参考。方法选择2017年11月至2020年12月我院收治的84例左肝内外胆管结石伴胆管炎患者作为研究对象,根据治疗方案的不同将其分为对照组和观察组,各42例。对照组采取腔镜下左半肝切除术,观察组采取腔镜下小范围切肝结合胆道扩张支撑术。比较两组的治疗效果。结果观察组的术中出血量少于对照组,下床活动时间、肛门排气时间、住院时间短于对照组,差异具有统计学意义(P<0.05)。治疗后24 h,观察组的去甲肾上腺素(NE)、皮质醇(Cor)、前列腺素E2(PGE2)水平低于对照组,差异具有统计学意义(P<0.05)。治疗后7 d,观察组的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、天冬氨酸氨基转移酶(AST)水平低于对照组,差异具有统计学意义(P<0.05)。治疗后7 d,观察组的生理、心理、环境、社会关系评分高于对照组,差异具有统计学意义(P<0.05)。结论腔镜下小范围切肝结合胆道扩张支撑术治疗左肝内外胆管结石伴胆管炎的效果较好,可减轻应激反应,促进肝胆功能恢复,提高生活质量,值得推广。

Objective To explore the effect of small range hepatectomy under laparoscopic combined with biliary tract dilatation support in the treatment of left intrahepatic and extrahepatic bile duct stone complicated with cholangitis,so as to provide reference for the selection of clinical operation methods.Methods A total of 84 patients with left intrahepatic and extrahepatic bile duct stone complicated with cholangitis admitted in our hospital from November 2017 to December 2020were selected as the research objects,and the patients were divided into control group and observation group according to different treatment schemes,with 42 cases in each group.The control group was treated with left liver resection under laparoscopic,and the observation group was treated with small range hepatectomy under laparoscopic combined with biliary tract dilatation support.The therapeutic effects of the two groups were compared.Results The intraoperative bleeding in the observation group was less than that in the control group,the ambulation time,anal exsufflation time and hospitalization time were shorter than those in the control group,and the differences were statistically significant(P<0.05).At 24 h after treatment,the levels of norepinephrine(NE),cortisol(Cor)and prostaglandin E2(PGE2)in the the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).At 7 d after treatment,the levels of alanine aminotransferase(ALT),total bilirubin(TBIL)and aspartate aminotransferase(AST)in the observation group were lower than those in control group,and the differences were statistically significant(P<0.05).At 7 d after treatment,the physiology,psychology,environment,social relations scores in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Small range hepatectomy under laparoscopic combined with biliary tract dilatation support in the treatment of left intrahepatic and extrahepatic bile duct stone complicated with cholangitis has a better effect,which can reduce the stress reaction,promote the recovery of hepatobiliary function,improve the quality of life,and it is worthy of promoting.