腹腔镜胆道镜钬激光碎石术联合肝叶切除术治疗肝内胆管结石患者的效果

Effects of laparoscopic choledochoscopic Holmium laser lithotripsy combined with hepatic lobectomy in treatment of patients with intrahepatic bile duct stones

目的:观察腹腔镜胆道镜钬激光碎石术联合肝叶切除术治疗肝内胆管结石患者的效果。方法:回顾性分析2018年8月至2023年8月该院收治的105例肝内胆管结石患者的临床资料,根据手术方法不同将其分为对照组52例与观察组53例。对照组行开腹胆总管切开取石术联合肝叶切除术治疗,观察组行腹腔镜胆道镜钬激光碎石术联合肝叶切除术治疗。比较两组结石清除率,围术期指标(手术时间、术中出血量、胃肠功能恢复时间、住院时间)水平,术后不同时间(术后1、3、5 d)疼痛[视觉模拟评分法(VAS)]评分,手术前后应激指标[皮质醇(Cor)、肾上腺素(E)]水平,以及并发症发生率。结果:观察组结石清除率为94.34%(50/53),高于对照组的73.08%(38/52),差异有统计学意义(P<0.05);观察组手术时间、胃肠功能恢复时间、住院时间短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05);术后1、3、5 d,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);术后3 d,两组Cor、E水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为3.77%(2/53),低于对照组的19.23%(10/52),差异有统计学意义(P<0.05)。结论:腹腔镜胆道镜钬激光碎石术联合肝叶切除术治疗肝内胆管结石患者可提高结石清除率,改善围术期指标水平,降低术后疼痛评分、应激指标水平和并发症发生率,效果优于开腹胆总管切开取石术联合肝叶切除术治疗。

Objective:To observe effects of laparoscopic choledochoscopic Holmium laser lithotripsy combined with hepatic lobectomy in treatment of patients with intrahepatic bile duct stones.Methods:The clinical data of 105 patients with intrahepatic bile duct stones admitted to the hospital from August 2018 to August 2023 were retrospectively analyzed.According to different surgical methods,they were divided into control group(52 cases)and observation group(53 cases).The control group was treated with open choledocholithotomy combined with hepatic lobectomy,while the observation group was treated with laparoscopic choledochoscopic Holmium laser lithotripsy combined with hepatic lobectomy.The stone clearance rate,the perioperative indexes(operation time,intraoperative blood loss,gastrointestinal function recovery time,hospitalization time)levels,the pain[visual analogue scale(VAS)]score at different time after the surgery(1,3,5 days after the surgery),the stress indexes[cortisol(Cor),epinephrine(E)]levels before and after the surgery,and the incidence of complications were compared between the two groups.Results:The stone clearance rate of the observation group was 94.34%(50/53),which was higher than 73.08%(38/52)of the control group,and the difference was statistically significant(P<0.05).The operation time,the gastrointestinal function recovery time and the hospitalization time of the observation group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant(P<0.05).1,3,5 days after the surgery,the VAS scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).3 days after the surgery,the levels of Cor and E in the two groups were higher than those before the surgery,but those in the observation group were lower than the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 3.77%(2/53),which was lower than 19.23%(10/52)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Laparoscopic choledochoscopic Holmium laser lithotripsy combined with hepatic lobectomy for the patients with intrahepatic bile duct stones can improve the stone clearance rate,improve the perioperative index levels,and reduce the postoperative pain scores,the stress index levels and the incidence of complications.Moreover,it is superior to open choledocholithotomy combined with hepatic lobectomy.