腹腔镜肝切除术与传统开腹肝切除术治疗肝内胆管结石的价值比

Comparison of laparoscopic hepatectomy and traditional open hepatectomy in the treatment of intrahepatic bile duct stones

目的比较腹腔镜肝切除术与传统开腹肝切除术治疗肝内胆管结石的临床价值。方法选取2020年1月至2022年5月于上饶东信第五医院确诊的80例肝内胆管结石患者作为研究对象,采用随机数字表法分为观察组与对照组,每组40例。对照组采用传统开腹肝切除术,观察组采用腹腔镜肝切除术,比较两组围手术期指标、术后并发症发生情况、结石清除率、手术效果、免疫功能指标、肝功能指标。结果观察组手术时间长于对照组,术中失血量少于对照组,术后住院时间、开始下床活动时间、恢复进食时间、镇痛时间、排气时间均短于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。两组即时结石清除率、最终结石清除率比较差异无统计学意义。观察组手术优良率高于对照组,差异有统计学意义(P<0.05)。术后,两组CD3^(+)、CD4^(+)水平均低于术前,CD8^(+)水平均高于术前,但观察组CD3^(+)、CD4^(+)水平均高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。术后,两组总胆红素(TBIL)、白蛋白(ALB)、丙氨酸转氨酶(ALT)水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论与传统开腹肝切除术相比,腹腔镜下肝内胆管结石切除术效果更佳,可促进术后快速恢复,减少并发症发生,提高结石清除率,增强机体免疫功能。

Objective To compare the clinical value of laparoscopic hepatectomy and traditional open hepatectomy in the treatment of intrahepatic bile duct stones.Methods A total of 80 patients with intrahepatic bile duct stones diagnosed in Shangrao Dongxin Fifth Hospital from January 2020 to May 2022 were selected as the study subjects,they were divided into the observation group and the control group by random number table method,with 40 cases in each group.The control group underwent traditional open hepatectomy,and the observation group underwent laparoscopic hepatectomy,the operative indexes,postoperative complications,stone clearance rate,operative effect,immune function and liver function indexs were compared between the two groups.Results The operative time in the observation group was longer than that in the control group,the intraoperative blood loss was less than that in the control group,and the postoperative hospitalization time,the time to get out of bed,the time to eat,the time to relieve pain and the time to exhaust were shorter than those in the control group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in immediate stone clearance and final stone clearance between the two groups.The excellent and good rate of operation in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).After operation,the levels of CD3^(+)and CD4^(+)of the two groups were lower than before operation,and the level of CD8^(+)were higher than before operation,but the levels of CD3^(+)and CD4^(+)in the observation group were higher than those in the control group,the levels of CD8^(+)was lower than that in the control group,and the differences were statistically significant(P<0.05).After operation,the levels of total bilirubin(TBIL),albumin(ALB)and alanine aminotransferase(ALT)of the two groups were higher than those before operation,and the observation group was higher than the control group,and the differences were statistically significant(P<0.05).Conclusion Compared with traditional open hepatectomy,laparoscopic intrahepatic cholelithiectomy has has a better effect,which can promote rapid postoperative recovery,reduce complications,increase stone clearance rate and enhance immune function.