经皮经肝胆道镜硬镜碎石术治疗胆结石患者的效果及对生活质量的影响

The effect of percutaneous transhepatic cholangioscopic lithotripsy on patients with gallstones and its impact on quality of life

目的探讨经皮经肝胆道镜(percutaneous transhepatic cholangioscopy,PTCS)硬镜碎石术治疗肝内胆管结石患者的临床效果。方法选取2019年3月至2022年1月绵阳市盐亭县人民医院收治的40例肝内胆管结石患者,根据随机数字表法分为观察组和对照组,各20例。对照组患者以传统腹腔镜肝内胆管取石术治疗,观察组以PTCS硬镜碎石术治疗,两组患者均于术后持续随访3个月。比较两组患者的手术相关指标、肝功能水平、生活质量、复发情况以及并发症发生情况。结果观察组患者的术中出血量低于对照组,住院时间、术后排气时间、手术时间均短于对照组,一次碎石成功率、术后2周结石排净率高于P对照组,差异均有显著性(<0.05)。与术前比,术后2周两组患者血清谷丙转氨酶、谷草转氨酶、总胆红素、血清白蛋白水平降低,观察组显著低于对照组;与术前比,术后3个月两组患者生理功能、躯体疼痛、健康状况、情感职能评分升高,其中观察组显著高于对照组;术后3个月内,观察组患者并发症总发生率、P复发率低于对照组,差异均有显著性(<0.05)。结论PTCS硬镜碎石术治疗肝内胆管结石患者能有效减轻肝脏损伤,恢复肝功能,提高患者生活质量,并降低并发症风险以及结石复发可能。

Objective To investigate the clinical effect of percutaneous transhepatic cholangioscopy(PTCS).Method hard lens lithotripsy in the treatment of intrahepatic bile duct stones From March 2019 to January 2022,40 patients with hepatolithiasis admitted to Yanting County People's Hospital,were selected and divided into the.observation group and the control group according to the random number table,with 20 patients in each group The patients in the control group were treated with traditional laparoscopic intrahepatic bile duct lithotomy,and.the patients in the observation group were treated with PTCS hard lens lithotripsy The patients in both groups.were followed up for 3 months after operation The operation related indexes,liver function level,quality of life,.Result recurrence and complications of the two groups were compared The intraoperative bleeding volume of the patients in the observation group was lower than that in the control group,and the hospital stay,postoperative.exhaust time,and operation time were shorter than those in the control group The success rate of primary lithotripsy and the stone clearance rate 2 weeks after operation were higher than those in the control group,with significant P.differences(<0.05)The levels of serum alanine aminotransferase,glutamic oxaloacetic transaminase,total bilirubin and serum albumin in the two groups were significantly lower than those in the control group 2 weeks after operation;The scores of physiological function,somatic pain,health status and emotional function of the patients in the two groups increased 3 months after operation compared with those before operation,and the scores in the observation group were significantly higher than those in the control group;Within 3 months after operation,the total incidence of complications and recurrence rate in the observation group were lower than those in the control group,with significant differences(P<0.05).Conclusion PTCS hard lens lithotripsy can effectively reduce liver injury,restore liver function,improve patients'quality of life,reduce the risk of complications and the possibility of stone recurrence.