腹腔镜肝切除术治疗复杂性肝内胆管结石的疗效分析

Clinical analysis of laparoscopic hepatectomy for the treatment of complex intrahepatic bile duct stones

目的分析腹腔镜肝切除术治疗复杂性肝内胆管结石的疗效。方法选取2017年1月—2021年9月黄山市人民医院收治的100例复杂性肝内胆管结石患者,遵循患者意愿,根据不同手术方法分为腹腔镜组和开腹组,每组50例。腹腔镜组给予腹腔镜肝切除术治疗,开腹组给予开腹肝切除术治疗。比较两组的疗效。结果腹腔镜组术后进食时间、肛门通气时间和住院时间均短于开腹组(P<0.05);两组间的即刻结石清除率、最终结石清除率和术后1年内的结石复发率比较,差异无统计学意义(P>0.05);术后,两组血清丙氨酸氨基转移酶、谷氨酰转移酶水平降低(P<0.05),血清白蛋白水平升高(P<0.05),腹腔镜组术前术后变化大于开腹组(P<0.05);腹腔镜组术后并发症发生率低于开腹组(P<0.05)。结论腹腔镜肝切除术治疗复杂性肝内胆管结石能加快患者术后恢复,结石清除率高,可减少术后结石复发率,有效改善肝功能,术后并发症少,疗效显著。

Objective To analyze the efficacy of laparoscopic hepatectomy in the treatment of complicated intrahepatic bile duct stones.Methods One hundred patients with complicated intrahepatic bile duct stones admitted to the People's Hospital of Huangshan City,Anhui Province,were selected from January 2017 to September 2021 and divided into laparoscopic group(n=50)and laparotomy group(n=50)according to different surgical methods based on the patient's wishes.Laparoscopic hepatectomy was performed in the laparoscopic group,and open hepatectomy was performed in the laparotomy group.The efficacy of the two groups was compared.Results The time of eating,anus ventilation and hospitalization in laparoscopic group were significantly shorter than those in laparotomy group(P<0.05).The immediate and final stone clearance rates in the laparoscopic group were higher than those in the laparotomy group,and the stone recurrence rate within 1 year after surgery was lower than that in the laparotomy group,but the difference between the two groups was not significant(P>0.05).After surgery,the levels of alanine aminotransferase and gamma-glutamyl transferase in the serum of the two groups were significantly reduced,while the levels of serum albumin were significantly increased,with significant differences between the two groups(P<0.05).The incidence of postoperative complications in the laparoscopic group was significantly lower than that in the laparotomy group(P<0.05).Conclusion Laparoscopic hepatectomy for the treatment of complex intrahepatic bile duct stones can speed up the recovery of patients after surgery,with a high stone clearance rate,and can reduce the recurrence rate of postoperative stones,effectively improve liver function,reduce postoperative complications,and has a significant effect.