腹腔镜引导肝叶切除术结合胆道镜取石术对老年肝内胆管结石患者肝胆功能、应激指标及并发症的影响

Effects of Laparoscope-guided Hepatic Lobectomy Combined with Choledochoscopic Lithotomy on Hepatobiliary Function,Stress Indexes and Complications in Elderly Patients with Intrahepatic Biliary Stones

目的:探究腹腔镜引导肝叶切除术结合胆道镜取石术对老年肝内胆管结石患者肝胆功能、应激指标及并发症的影响。方法:选取贺州市中医医院2020年3月—2022年10月收治的160例老年肝内胆管结石患者,按随机数字表法分两组,所有患者均行腹腔镜引导肝叶切除术,对照组(n=80)行经肝实质胆管切开取石术,观察组(n=80)行胆道镜取石术。比较两组围手术期指标、肝胆功能、应激指标及并发症发生率。结果:观察组术中出血量少于对照组,术后排气时间早于对照组,术后住院时间短于对照组,差异均有统计学意义(P<0.05)。术前两组肝胆功能指标比较,差异均无统计学意义(P>0.05);术后两组总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(AKP)、γ-谷氨酰转移酶(GGT)均低于术前,且观察组TBIL、DBIL、ALT、AST、AKP、GGT均明显低于对照组,差异均有统计学意义(P<0.05)。两组术前肾上腺素、心率对比,差异均无统计学意义(P>0.05);术后,两组上述应激指标均上升,但观察组肾上腺素及心率均较对照组低(P<0.05)。观察组并发症发生率较对照组低(P<0.05)。结论:肝内胆管结石采用腹腔镜引导肝叶切除术+胆道镜取石术治疗,可改善患者肝胆功能,减轻应激反应,减少并发症发生。

Objective:To investigate the effects of laparoscope-guided hepatic lobectomy combined with choledochoscopic lithotomy on hepatobiliary function,stress indexes and complications in elderly patients with intrahepatic biliary stones.Method:A total of 160 elderly patients with intrahepatic biliary stones treated in Hezhou Hospital of Traditional Chinese Medicine from March 2020 to October 2022 were selected and divided into two groups according to random number table method.All patients underwent laparoscope-guided hepatic lobectomy,and the control group(n=80)underwent transhepatic cholangiolithotomy,the observation group(n=80)underwent choledochoscopic lithotomy.Perioperative period indexes,hepatobiliary function,stress indexes and complication rate were compared between the two groups.Result:The intraoperative bleeding volume in the observation group was less than that in the control group,the postoperative exhaust time was earlier than that in the control group,postoperative hospital stay was shorter than that in the control group,the differences were statistically significant(P<0.05).There were no significant differences in hepatobiliary function indexes between the two groups before surgery(P>0.05).After surgery,the total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(AKP)andγ-glutamyltransferase(GGT)in both groups were lower than those before surgery,and TAIL,BILL,ALT,AST,AKP and GGT in observation group were significantly lower than those in control group,the differences were statistically significant(P<0.05).There were no significant differences in adrenaline and heart rate before surgery between the two groups(P>0.05).After surgery,the above stress indexes in both groups were increased,but adrenaline and heart rate in the observation group were lower than those in the control group(P<0.05).The complication rate of observation group was lower than that of control group(P<0.05).Conclusion:Laparoscope-guided hepatic lobectomy+choledochoscopic lithotomy in the treatment of intrahepatic biliary stones can improve the hepatobiliary function,relieve the stress reaction and reduce the occurrence of complications.