胆道镜下肝胆管切开取石术对肝内胆管结石患者术后结石残留率及并发症发生率的影响

Effect of choledochoscopic hepatolithotomy on postoperative stone residual rate and complication rate of patients with intrahepatic bile duct calculus

目的探究胆道镜下肝胆管切开取石术对肝内胆管结石患者术后结石残留率及并发症发生率的影响。方法选取2019年3月至2021年9月上饶市立医院收治的60例肝内胆管结石患者作为研究对象,随机分为观察组与对照组,每组30例。观察组行胆道镜下肝胆管切开取石术,对照组行肝部分切除术。比较两组应激指标、炎症指标、围手术期指标、并发症发生率、临床疗效、结石残留率及复发率。结果术后,观察组前列腺素E2(PGE2)、皮质醇(Cor)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平均低于对照组,差异有统计学意义(P<0.05);观察组术中失血量少于对照组,手术时间、下床活动时间、首次排便时间、首次排气时间、住院时间均短于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为6.67%,低于对照组的26.67%,差异有统计学意义(P<0.05);观察组治疗总有效率为96.67%,高于对照组的73.33%,差异有统计学意义(P<0.05);观察组结石残留率、复发率均低于对照组,差异有统计学意义(P<0.05)。结论胆道镜下肝胆管切开取石术治疗肝内胆管结石效果显著,手术创伤小,不易诱发应激反应及炎症因子,且并发症少,结石残留率、复发率较低,恢复速度快,值得临床推广应用。

Objective To investigate the effect of choledochoscopic hepatolithotomy on postoperative stone residual rate and complication rate of patients with intrahepatic bile duct calculus.Methods Atotal of 60 patients with intrahepatic bile duct stones admitted to Shangrao Municipal Hospital from March 2019 to September 2021 were selected as the study subjects,and they were randomly divided into the observation group and the control group,with 30 cases in each group.The observation group underwent choledochoscopic hepatolithotomy and the control group underwent partial hepatectomy.The stress index,inflammation index,perioperative index,complication rate,clinical efficacy,stone residual rate and recurrence rate were compared between the two groups.Results After operation,the levels of prostaglandin E2(PGE2),cortisol(Cor),tumor necrosis factor-α(TNF-α)and hypersensitive C-reactive protein(hs-CRP)in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The intraoperative blood loss in the observation group was less than that in the control group,and the operative time,the time of getting out of bed,the time of first defecation,the time of first exhaust and the time of hospitalization were shorter than those in the control group,the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 6.67%,which was lower than 26.67%in the control group,the difference was statistically significant(P<0.05).The total effective rate of the observation group was 96.67%,which was higher than 73.33%in the control group,and the difference was statistically significant(P<0.05).The stone residual rate and recurrence rate in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Choledochoscopic hepatolithotomy is effective in the treatment of intrahepatic cholelithiasis,with less trauma,less stress response and inflammatory factors,fewer complications,lower stone residual rate and recurrence rate,and fast recovery rate,which is worthy of clinical promotion and application.