腹腔镜中路纵剖法取石术治疗复杂性肝胆结石的效果

Effect of laparoscopic mid-longitudinal lithotomy in the treatment of complex hepatolithiasis

目的 探究腹腔镜中路纵剖法取石术治疗复杂性肝胆结石的效果。方法 选取146例复杂性肝胆结石患者为研究对象,根据手术方法的不同将其分为中路纵剖组(75例,采用腹腔镜中路纵剖法取石术)与常规组(71例,采用常规腹腔镜取石术)。比较2组患者结石残留率、手术相关指标及手术前后肝功能指标、炎症因子水平、胃肠功能相关指标,并比较2组患者术后胆管出血、黄疸等并发症的发生情况。结果 中路纵剖组、常规组的结石残留率分别为1.33%(1/75)、5.63%(4/71),2组比较差异无统计学意义(P>0.05);中路纵剖组的中转开腹率低于常规组,术中出血量多于常规组,术后排气时间及住院时间短于常规组,差异均有统计学意义(P<0.05);中路纵剖组术后3 d的AST、ALT、TBIL、TNF-α、IL-6、CRP水平及术后1周的胃泌素水平均低于常规组,术后1周的胃动素水平高于常规组(P<0.05);2组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论 与常规腹腔镜取石术相比,腹腔镜中路纵剖法取石术治疗复杂性肝胆结石的中转开腹率较低,可降低机体炎症因子水平,促进患者术后肝功能及胃肠功能恢复。

Objective To explore the effect of laparoscopic mid-longitudinal lithotomy in the treatment of complex hepatolithiasis.Methods A total of 146 patients with complex hepatolithiasis were selected as the research subjects. According to the different surgical methods, they were divided into the mid-longitudinal group(75 cases, received laparoscopic mid-longitudinal lithotomy) and the conventional group(71 cases, conventional laparoscopic lithotomy). The stone residual rate, surgery-related indicators as well as liver function indicators, inflammatory factors levels and gastrointestinal function-related indicators before and after surgery were compared between the two groups. The incidence of postoperative complications such as bile duct hemorrhage and jaundice in the two groups were compared.Results The stone residual rate was 1.33%(1 of 75) in the mid-longitudinal group and that in the conventional group was 5.63%(4 of 71),and there was no statistically significant difference between the two groups(P>0.05). The conversion rate to laparotomy in the mid-longitudinal group was lower than that in the conventional group, the intraoperative blood loss was more than that in the conventional group, and the postoperative exhaust time and hospital stay were shorter than those in the conventional group, the differences were statistically significant(P<0.05). The levels of AST,ALT,TBIL,TNF-α,IL-6 and CRP 3 days after surgery and the level of gastrin 1 week after surgery in the mid-longitudinal group were lower than those in the conventional group, while the level of motilin 1 week after surgery was higher than that in the conventional group(P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion Compared with conventional laparoscopic lithotomy, laparoscopic mid-longitudinal lithotomy in the treatment of complex hepatolithiasis has a lower conversion rate to laparotomy, which can reduce the inflammatory factors levels in the body and promote the recovery of liver function and gastrointestinal function of patients after surgery.