腹腔镜肝切除术治疗左肝内胆管结石患者的效果分析

Effect analysis of laparoscopic hepatectomy in patients with left intrahepatic bile duct stones

目的探析腹腔镜肝切除术治疗左肝内胆管结石患者的效果。方法87例左肝内胆管结石患者,根据手术方法的不同分为甲组(43例)与乙组(44例)。甲组患者行开腹肝切除术治疗,乙组患者行腹腔镜肝切除术治疗。比较两组手术相关指标、并发症发生情况、结石清除率和复发率及手术前后肝功能指标[总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)]、炎症因子[白细胞计数(WBC)、C反应蛋白(CRP)、中性粒细胞]。结果乙组手术时间(109.89±26.34)min、切口长度(6.14±1.19)cm、首次排气时间(1.17±0.32)d、住院时间(6.89±1.17)d短于甲组的(202.15±23.62)min、(10.05±1.28)cm、(1.87±0.39)d、(9.36±1.08)d,术中出血量少于甲组,差异有统计学意义(P<0.05)。乙组并发症发生率6.82%低于甲组的23.26%,差异有统计学意义(P<0.05)。手术后,两组ALT、TBil均低于本组手术前,且乙组ALT明显低于甲组,差异有统计学意义(P<0.05)。甲组手术后ALB低于本组手术前,差异有统计学意义(P<0.05);乙组手术后ALB明显高于甲组,差异有统计学意义(P<0.05)。手术后,两组WBC、CRP、中性粒细胞均高于本组手术前,但乙组WBC、CRP、中性粒细胞均明显低于甲组,差异有统计学意义(P<0.05)。乙组结石清除率97.73%明显高于甲组的81.40%,差异有统计学意义(P<0.05);甲组结石复发率为6.98%,与乙组的2.27%比较,差异无统计学意义(P>0.05)。结论对左肝内胆管结石患者行腹腔镜肝切除术治疗,清除结石效果要明显优于开腹肝切除术,还可缩短患者住院时间。

Objective To explore the effect of laparoscopic hepatectomy in patients with left intrahepatic bile duct stones.Methods A total of 87 patients with left intrahepatic bile duct stones were divided into group A(43 cases)and group B(44 cases)according to different surgical methods.Group A underwent open hepatectomy,and group B underwent laparoscopic hepatectomy.Both groups were compared in terms of surgery-related indicators,complications,stone clearance rate,recurrence rate,liver function indicators[total bilirubin(TBil),alanine aminotransferase(ALT),albumin(ALB)],inflammatory factors[white blood cell count(WBC),C-reactive protein(CRP),neutrophils]before and after surgery.Results The operative time in group B was(109.89±26.34)min,the incision length was(6.14±1.19)cm,the first exhaust time was(1.17±0.32)d and the length of hospital stay was(6.89±1.17)d,which were shorter than those of(202.15±23.62)min,(10.05±1.28)cm,(1.87±0.39)d and(9.36±1.08)d in group A;the intraoperative blood loss in group B was less than that in group A;the differences were statistically significant(P<0.05).The complication rate of 6.82%in group B was lower than that of 23.26%in group A,and the difference was statistically significant(P<0.05).After surgery,ALT and TBil in both groups were lower than those before surgery in this group,and ALT in group B was significantly lower than that in group A.The differences were statistically significant(P<0.05).ALB in group A after surgery was lower than that before surgery,and the difference was statistically significant(P<0.05).After surgery,ALB in group B was significantly higher than that in group A,and the difference was statistically significant(P<0.05).After surgery,WBC,CRP and neutrophils in both groups were higher than those before surgery in this group,but WBC,CRP and neutrophils in group B were significantly lower than those in group A,and the differences were statistically significant(P<0.05).The stone clearance rate of 97.73%in group B was higher than that of 81.40%in group A,and the difference was statistically significant(P<0.05).The recurrence rate in group A was 6.98%,which had no statistically significant difference compared with that of 2.27%in group B(P>0.05).Conclusion Laparoscopic hepatectomy for patients with left intrahepatic bile duct stones is significantly better than open hepatectomy for stone removal and can shorten the length of hospital stay.