左半肝切除术联合胆道镜治疗对复杂肝内胆管结石患者应激反应肝功能的影响研究

Effects of Left Hemihepatectomy Combined with Choledochoscopy on Stress Response and Liver Function in Patients with Complicated Intrahepatic Bile Duct Stones

目的:分析左半肝切除术联合胆道镜治疗对复杂肝内胆管结石患者应激反应和肝功能的影响。方法:回顾分析2019年1月至2021年12月我院收治的复杂肝内胆管结石患者82例,依据手术方式的的不同分为研究组(n=43,接受腹腔镜左半肝切除术联合胆道镜取石治疗)和对照组(n=39,接受腹腔镜左半肝切除术治疗)。比较两组患者的临床疗效,术前和术后3d两组患者应激指标皮质醇(COR)、肾上腺素(EP)和C反应蛋白(CRP)变化,以及术前和术后7d肝功能谷丙转氨酶(ALT)、血清总胆红素(TBIL)以及谷氨酰转移酶(GGT)水平,比较两组患者术后胆漏、感染、结石残留和胸腔积液等并发症的发生率。结果:研究组的临床有效率为93.02%高于对照组的76.92%,差异有统计学意义(P<0.05),且研究组疗效等级优于对照组(P<0.05);术后两组患者COR、EP和CRP水平均高于术前(P<0.05),两组术前术后差值比较无统计学意义(P>0.05);术后,两组患者ALT、TBIL和GGT均较术前降低,且研究组患者ALT、TBIL和GGT均低于对照组,研究组患者术前术后肝功能指标差值高于对照组(P<0.05);研究组患者胆漏、感染、结石残留和胸腔积液的发生率为4.66%,低于对照组的20.51%(P<0.05)。结论:腹腔镜左半肝切除术联合胆道镜治疗复杂肝内胆管结石的临床疗效好,对患者应激反应影响较小,且能够改善患者的肝功能,减少并发症,临床值得应用推广。

Objective:To analyze the effects of left hemihepatectomy combined with choledochoscopy on stress response and liver function in patients with complicated intrahepatic bile duct stones.Methods:The 82 patients with complicated intrahepatic bile duct stones admitted to our hospital from January 2019 to December 2021 were retrospectively analyzed and divided into a study group(n=43,treated by laparoscopic left hepatectomy combined with choledochoscopic stone extraction)and a control group(n=39,treated by laparoscopic left hepatectomy)according to the different surgical methods.The clinical outcomes,changes in stress indicators cortisol(COR),epinephrine(EP)and C-reactive protein(CRP)before and 3d after surgery,and the levels of liver function ghrelin(ALT),serum total bilirubin(TBIL)and glutamyl transferase(GGT)before and 7d after surgery were compared between the two groups,as well as the incidence of postoperative complications such as bile leakage,infection,stone retention and pleural effusion.Results:The clinical effective rate of 93.02%in study group was higher than 76.92%in control group(P<0.05),the difference was statistically significant(P<0.05),and the efficacy grading was better than that in control group(P<0.05).The levels of COR,EP and CRP in the two groups after surgery were higher than those before surgery(P<0.05),and the differences of levels before and after surgery showed no statistical significance between the two groups(P>0.05).After surgery,the ALT,TBIL and GGT in the two groups were reduced compared with those before surgery,and the above levels were lower in study group than those in control group,and the differences of liver function indicators before and after surgery in study group were higher compared to control group(P<0.05).The total incidence rate of bile leakage,infection,residual stone and pleural effusion was 4.66%in study group,which was lower than 20.51%in control group(P<0.05).Conclusion:Laparoscopic left hemihepatectomy combined with choledochoscopy has a good clinical efficacy and has small impact on stress response in the treatment of complicated intrahepatic bile duct stones,and it can improve the liver function and reduce the complications,thus it is worthy of clinical application and promotion.