两种取石术对复杂肝内胆管结石患者血清炎症因子及肝功能的影响

Effects of Two Kinds of Lithotomy on Serum Inflammatory Factors and Liver Function in Patients with Complex Intrahepatic Bile Duct Stones

目的:分析经皮经肝穿刺胆道镜取石术(PTCSL)与腹腔镜胆总管探查取石术(LCBDE)对复杂肝内胆管结石患者血清炎症因子及肝功能的影响。方法:选取宜春新建医院2020年2月—2023年8月收治的100例复杂肝内胆管结石患者纳入研究,通过电脑随机编号的方法分为胆道镜组(n=50)和腹腔镜组(n=50)。胆道镜组给予经皮经肝穿刺胆道镜取石术治疗,腹腔镜组给予腹腔镜胆总管探查取石术治疗。比较术前和术后两组患者血清炎症因子[白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)]和肝功能指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和γ-谷氨酰转肽酶(γ-GT)],记录两组治疗效果、并发症发生情况和术后半年复发情况。结果:术后3 d,两组患者IL-6、TNF-α、CRP、AST、ALT和GTT水平均较术前1 d降低,且腹腔镜组均低于胆道镜组,差异均有统计学意义(P<0.05)。腹腔镜组手术时间、住院时间均短于胆道镜组,术中出血量少于胆道镜组,差异均有统计学意义(P<0.05)。腹腔镜组临床总有效率高于胆道镜组(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。腹腔镜组复发率低于胆道镜组(P<0.05)。结论:采用腹腔镜胆总管探查取石术治疗复杂肝内胆管结石,不仅可以降低患者的炎症水平,改善肝功能,还可以促进患者快速康复。

Objective:To analyze the effects of percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)versus laparoscopic common bile duct exploration(LCBDE)on serum inflammatory factors and liver function in patients with complex intrahepatic bile duct stones.Method:A total of 100 patients with complex intrahepatic bile duct stones treated at Yichun Xinjian Hospital from February 2020 to August 2023 were selected for this study.They were divided into cholangioscopy group(n=50)and laparoscopy group(n=50)by computer random numbering method.The cholangioscopy group received PTCSL,while the laparoscopy group underwent LCBDE.The preoperative and postoperative serum levels of inflammatory markers[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and C reactive protein(CRP)]and liver function indicators[aspartate aminotransferase(AST),alanine aminotransferase(ALT),and gamma-glutamyl transferase(γ-GT)]were compared between the two groups,the therapeutic effect,the occurrence of complications and the recurrence of six months after operation were recorded in the two groups.Result:3 d after surgery,the levels of IL-6,TNF-α,CRP,AST,ALT andγ-GT in two groups were lower than those 1 d before surgery,and those of the laparoscopy group were lower than those of the cholangioscopy group,the differences were statistically significant(P<0.05).The operation time and hospital stay of laparoscopy group were shorter than those of cholangioscopy group,and the intraoperative blood loss was less than that of cholangioscopy group,the differences were statistically significant(P<0.05).The total clinical effective rate of laparoscopy group was higher than that of cholangioscopy group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The recurrence rate of laparoscopy group was lower than that of cholangioscopy group(P<0.05).Conclusion:LCBDE can not only reduce the inflammation level of patients,improve liver function,but also promote rapid recovery of patients.