超声引导下肝切除术、精准区段肝蒂肝切除术对肝胆管结石患者机体炎症反应的影响

Effects of ultrasound-guided hepatectomy and precise segmental pedicle hepatectomy on inflammatory response in patients with hepatolithiasis

目的对比超声引导下肝切除术、精准区段肝蒂肝切除术治疗肝胆管结石(HC)患者的效果及对患者机体炎症反应的影响。方法回顾性收集2021年1月至2023年6月郑州大学附属郑州中心医院90例HC患者的病例资料,按手术方案不同分两组。以接受精准区段肝蒂肝切除术治疗的45例患者列为A组,以接受超声引导下肝切除术治疗的45例患者列为B组。对比两组围手术期指标、术前、术后14 d肝功能指标[碱性磷酸酶(ALP)、谷丙转氨酶(ALT)、总胆红素(TBIL)、谷草转氨酶(AST)]、免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、炎症指标[白三烯B4(LTB4)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]水平、结石残留率、并发症发生率。结果A组术后肝断面引流量、术中失血量相较于B组更低(P<0.05),两组排气时间、手术用时相比差异无统计意义(P>0.05);A组术后14 d血清ALP、ALT、TBIL、AST水平相较于B组更低(P<0.05);A组术后14 d CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平相较于B组更高(P<0.05);A组术后14 d血清LTB4、TNF-α、IL-6水平相较于B组更低(P<0.05);A组结石残留率、并发症总发生率6.67%(3/45)、4.44%(2/45)相较于B组28.89%(13/45)、22.22%(10/45)更低(P<0.05)。结论相较于超声引导下肝切除术治疗,通过精准区段肝蒂肝切除术治疗不仅能进一步降低术后肝断面引流量、术中失血量,缓解机体炎症反应,提升免疫功能,改善肝功能,同时还可进一步降低结石残留率及并发症发生率。

【Objective】To compare the effects of ultrasound-guided hepatectomy and precise segmental-pedicled hepatectomy in the treatment of patients with hepatic calculus(HC)and the effects on the inflammatory response of the patients.【Methods】The data of 90 patients with HC in Zhengzhou Central Hospital(January 2021 to June 2023)were retrospectively collected and divided into 2 groups according to different surgical protocols.Forty-five patients receiving precise segmental pedicle hepatectomy were classified as group A,and 45 patients receiving ultrasound-guided hepatectomy were classified as group B.The perioperative indexes of the two groups,as well as liver function indexes[alkaline phosphatase(ALP),alanine transaminase(ALT),total bilirubin(TBIL),aspartate transaminase(AST)],immune function indexes(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),inflammatory markers[leukotriene B4(LTB4),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]levels,stone residue rate,and complication rate before and 14 days after surgery were compared.【Results】The postoperative liver cross-sectional drainage volume and intraoperative blood loss in group A were lower than those in group B(P<0.05),and there was no significant difference in exhaust time and surgical time between the two groups(P>0.05).The serum levels of ALP,ALT,TBIL,and AST in group A were lower than those in group B on the 14th day after surgery(P<0.05).The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in group A were higher than those in group B on the 14th day after surgery(P<0.05).Fourteen days after surgery,serum level of LTB4,TNFαand IL-6 in group A was lower compared with group B(P<0.05).The residual rate of stones and total incidence of complications in group A were 6.67%(3/45)and 4.44%(2/45),which were lower than those in group B[28.89%(13/45)and 22.22%(10/45)](P<0.05).【Conclusion】Compared with ultrasound-guided hepatectomy for the treatment of HC patients,precise segmental hepatectomy can not only further reduce postoperative liver cross-sectional drainage flow and intraoperative blood loss,alleviate inflammatory reactions,enhance immune function,and improve liver function,but also further reduce the incidence of stone residue and complications.