Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra-and extrahepatic bile duct stones

BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver cancer.Currently,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there is a risk of postoperative complic-ations.AIM To compare the clinical effects of dual-modality endoscopy(duodenoscopy and laparoscopy)with those of traditional laparotomy in the treatment of intra-and extrahepatic BDSs.METHODS Ninety-five patients with intra-and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected;45 patients in the control group were treated by traditional laparotomy,and 50 patients in the research group were treated by dual-modality endoscopy.The following factors were collected for analysis:curative effects,safety(incision infection,biliary fistula,lung infection,hemobilia),surgical factors[surgery time,intraoperative blood loss(IBL)volume,gastrointestinal function recovery time,and length of hospital stay],serum inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-8],and oxidative stress[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and advanced protein oxidation products(AOPPs)].RESULTS The analysis revealed markedly better efficacy(an obviously higher total effective rate)in the research group than in the control group.In addition,an evidently lower postoperative complication rate,shorter surgical duration,gastrointestinal function recovery time and hospital stay,and lower IBL volume were observed in the research group.Furthermore,the posttreatment serum inflammatory marker(TNF-α,IL-6,and IL-8)levels were significantly lower in the research group than in the control group.Compared with those in the control group,the posttreatment GSH-Px,SOD,MDA and AOPPs in the research group were equivalent to the pretreatment levels;for example,the GSH-Px and SOD levels were significantly higher,while the MDA and AOPP levels were lower.CONCLUSION Dual-modality endoscopy therapy(duodenoscopy and laparoscopy)is more effective than traditional laparotomy in the treatment of intra-and extrahepatic BDSs and has a lower risk of postoperative complications;significantly shortened surgical time;shorter gastrointestinal function recovery time;shorter hospital stay;and lower intraop-erative bleeding volume,while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.

Nursing Effect of Rapid Rehabilitation Surgery Concept in Laparoscopic Surgery for Extrahepatic Bile Duct Stones

Objective: To explore the application value of rapid rehabilitation concept in patients with extrahepatic bile duct stones under laparoscopy during perioperative period. Methods: 90 patients with extrahepatic bile duct stones treated in our hospital from January 2022 to February 2023 were selected as the research object and randomly divided into the study group and the control group. The control group was given routine care, and the observation group was given rapid surgical rehabilitation care. The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time, hospitalization time and complication rate were compared between the two groups. The independent sample T test was used for the measurement data, and the x2 test was used for the counting data, and the difference was statistically significant (P Results: The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time and hospitalization time in the study group were shorter than those in the control group (all P Conclusion: The concept of rapid rehabilitation can significantly improve the perioperative nursing effect of patients with extrahepatic bile duct stones and accelerate their rehabilitation, which is worth improving and popularizing.

Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea

BACKGROUND Intrahepatic duct(IHD)stones are among the most important risk factors for cholangiocarcinoma(CCC).Approximately 10%of patients with IHD stones develop CCC;however,there are limited studies regarding the effect of IHD stone removal on CCC development.AIM To investigate the association between IHD stone removal and CCC development.METHODS We retrospectively analyzed 397 patients with IHD stones at a tertiary referral center between January 2011 and December 2020.RESULTS CCC occurred in 36 of the 397 enrolled patients.In univariate analysis,chronic hepatitis B infection(11.1%vs 3.0%,P=0.03),carbohydrate antigen 19-9(CA19-9,176.00 vs 11.96 II/mL,P=0.010),stone located in left or both lobes(86.1%vs 70.1%,P=0.042),focal atrophy(52.8%vs 26.9%,P=0.001),duct stricture(47.2%vs 24.9%,P=0.004),and removal status of IHD stone(33.3%vs 63.2%,P<0.001)were significantly different between IHD stone patients with and without CCC.In the multivariate analysis,CA19-9>upper normal limit,carcinoembryonic antigen>upper normal limit,stones located in the left or both lobes,focal atrophy,and complete removal of IHD stones without recurrence were independent factors influencing CCC development.However,the type of removal method was not associated with CCC risk.CONCLUSION Complete removal of IHD stones without recurrence could reduce CCC risk.

Intraductal ultrasonography and endoscopic retrograde cholangiography in diagnosis of extrahepatic bile duct stones: a comparative study

BACKGROUND: Intraductal ultrasonography (IDUS) is highly accurate in detection of extrahepatic bile duct stones. This study was to compare the accuracy of IDUS and endo- scopic retrograde cholangiography (ERC) in the diagnosis of extrahepatic bile duct stones. METHODS: Thirty patients suspected of extrahepatic bile duct stones on B ultrasonography, CT, or MRI were en- rolled for study. ERC was performed using a Fujinon duo- denoscope (ED-410XT, ED-410Xu), then IDUS was done by inserting a Fujinon microprobe (PL2220-15) through the endoscopic biopsy channel to detect the extrahepatic bile duct. Finally stones in the extrahepatic bile duct were detected and extracted by endoscopic sphincterotomy (EST). RESULTS: Among the 30 patients, 26 were diagnosed as having cholelithiasis accurately through ERC. In one pa- tient the stone detected by ERC was really floccule. Mis- diagnosis happened in 2 patients with extrahepatic bile duct stones. So the overall accuracy and sensitivity of ERC in the diagnosis of extrahepatic bile duct stones were 86.7% (26/30) and 92.9% (26/28) respectively. In contrast, IDUS showed the results of diagnosis were in consistent with those of EST stone extraction. Its accuracy and sensi- tivity in the diagnosis of extrahepatic bile duct stones were 100% (30/30) and 100% (28/28) respectively. CONCLUSION: IDUS which is superior to ERC in diagno- sing extrahepatic bile duct stones can avoid the visual error of ERC.

Clinical and biological significance of precursor lesions of intrahepatic cholangiocarcinoma

Cholangiocarcinoma(CC) is primarily a malignant tumor of older adults most prevalent in Southeast Asia,where liver fluke infestation is high.However the etiology in western countries is unknown.Although the incidence of extrahepatic cholangiocarcinoma has remained constant,incidence of intrahepatic CC(ICC) which differs inmorphology,pathogenesis,risk factors,treatment and prognosis is increasing.While this increase is associated with hepatitis C virus infection,chronic nonalcoholic liver disease,obesity,and smoking,the pathogenesis of ICC and molecular alterations underlying the carcinogenesis are not completely elucidated.Benign biliary lesions such as biliary intraepithelial neoplasia,intraductal papillary neoplasm of the bile duct,von Meyenburg complex or bile duct hamartoma,and bile duct adenoma have been associated with ICC.For each of these entities,evidence suggests or supports a role as premalignant lesions.This article summarized the important biological significance of the precursor lesions of ICC and the molecular mechanisms that may be involved in intrahepatic cholangiocarcinogenesis.

Postoperative jaundice related to UGT1A1 and ABCB11 gene mutations:A case report and literature review

BACKGROUND Patients with obstructive jaundice caused by intrahepatic bile duct stones can be effectively managed by surgery.However,some patients may develop postope-rative complications,liver failure,and other life-threatening situations.Here,we report a patient with mutations in the uridine 5’-diphospho-glucuronosyltrans-ferase 1A1(UGT1A1)and bile salt export pump(adenosine triphosphate-binding cassette subfamily B member 11,ABCB11)genes who presented multiple intrahe-patic bile duct stones and cholestasis,and the jaundice of the patient increased after partial hepatectomy.CASE SUMMARY A 52-year-old male patient admitted to the hospital on October 23,2021,with a progressive exacerbation of jaundice,was found to have multiple intrahepatic bile duct stones with the diagnoses of obstructive jaundice and acute cholecystitis.Subsequently,the patient underwent left hepatectomy with biliary exploration,stone extraction,T-tube drainage,and cholecystectomy without developing any intraoperative complications.The patient had a dark urine color with worsening jaundice postoperatively and did not respond well to plasma exchange and other symptomatic and supportive treatments.Since the progressive increase in postoperative bilirubin could not be clinically explained with any potential reason,including,if not at all,viral infection,cholangitis,autoimmune liver disease,and other causes,the patient underwent whole-exon screening for any genetic diseases,which surprisingly identified UGT1A1 and ABCB11 gene mutations related to glucuronidation of indirect bilirubin as well as bile acid transport in hepatocytes,respectively.Thus,we hypothesized that postoperative refractory cholestasis might result from UGT1A1 and ABCB11 gene mutations and further recommended liver transplantation to the patient,who eventually declined it and died from liver failure six months later.CONCLUSION Surgery may aggravate cholestasis in patients with multiple intrahepatic bile duct stones and cholestasis associated with UGT1A1 and ABCB11 gene mutations.A liver transplant may be the best option if active medical treatment fails.

腹腔镜联合胆道镜治疗左肝内胆管结石合并胆总管结石的安全性及有效性分析

目的:研究腹腔镜联合胆道镜治疗左肝内胆管结石同时合并胆总管结石的效果,同时探讨安全性及有效性。方法:选取萍乡市人民医院肝胆胰外科2018年1月—2022年12月收治的左肝内胆管结石合并胆总管结石患者180例作为研究对象,按照随机数字表法分为观察组(90例)和对照组(90例)。观察组的患者使用腹腔镜左肝切除及胆道镜取石,对照组的患者采取常规开腹左肝切除及胆道镜取石,比较两组患者相关手术时间、术中出血量、术后患者结石残留率、并发症发生率,比较两组患者术后下地时间、胃肠道功能恢复时间、术后住院时间及肝功能变化等指标。结果:观察组的手术时间长于对照组,其术中出血量少于对照组,术后下地时间、术后胃肠道功能恢复时间、术后住院时间均明显短于对照组(P<0.05)。观察组术后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TBIL)的水平均明显低于对照组(P<0.05)。观察组围手术期切口感染、胆漏、胆道出血及肺部感染的发生率为6.67%(6/90),显著低于对照组的16.67%(15/90)(P<0.05)。术后随访显示,观察组结石残留率为3.33%(3/90),对照组为2.22%(2/90),两组间结石残留率差异无统计学意义(P>0.05)。结论:腹腔镜肝切除联合胆道镜取石治疗左肝内胆管结石合并胆总管结石可减少手术创伤,加快患者康复,改善肝功能,减少术后并发症,取石效果好,安全可靠。

ERAS理念在腹腔镜肝切除术治疗肝内胆管结石中的应用

目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗的63例肝内胆管结石肝萎缩病人的临床资料,根据围手术期处理方法不同将其分为ERAS组(32例)和对照组(常规组,31例)。比较分析ERAS理念对病人术中情况(手术时间及术中出血量)、住院费用、术后肝功能、康复时间及并发症等指标的影响。呈偏态分布的计量资料以M(Q1,Q3)表示,采用秩和检验。结果ERAS组与对照组比较,病人术后康复时间明显缩短[6.0(5.0,7.0)d比8.0(5.0,9.0)d,P<0.01],住院费用更少[46531(38676,51311)元比55553(47638,65529)元,P<0.01],并发症发生率更低[31.3%(10/32)比93.5%(29/31),P<0.01],术后留置T管率更低[28.1%(9/32)比58.1%(18/31),P<0.01];两组病人在手术时间、出血量以及术后1 d、3 d的血谷丙转氨酶、谷草转氨酶、C反应蛋白及预后营养指数方面差异均无统计学意义(均P>0.05)。结论ERAS理念应用于肝切除治疗肝胆管结石肝萎缩的围手术期管理是安全有效的,有助于病人的快速安全康复,值得在肝内胆管结石肝切除术中推广。

腹腔镜解剖性肝Ⅲ段切除治疗左肝区域性肝内胆管结石临床效果

目的 探讨腹腔镜解剖性肝Ⅲ段切除治疗左肝区域性肝内胆管结石的手术要点、适应证及可行性。方法 采用回顾性描述性研究方法,收集2021年8月至2022年10月湘雅常德医院(3例)和湘西土家族苗族自治州人民医院(1例)收治的4例局限于肝Ⅲ段的肝内胆管结石患者临床资料,其中男1例,女3例,中位年龄61.5(45.0~69.0)岁。4例患者中,2例为单纯性肝Ⅲ段肝内胆管结石,1例为肝Ⅲ段肝内胆管结石合并胆囊结石、胆总管结石,1例为肝Ⅲ段肝内胆管结石合并胆囊结石。4例患者均接受腹腔镜解剖性肝Ⅲ段切除术式治疗局限于肝Ⅲ段的肝内胆管结石。结果 4例患者均顺利完成腹腔镜解剖性肝Ⅲ段切除术,其中1例实施联合肝左静脉重建的解剖性肝Ⅲ段切除术。无中转开腹病例及切肝范围的变更。手术时间分别为280 min、440 min、220 min及110 min;第一肝门阻断时间分别为60 min、60 min、75 min和25 min。术中均无输血。4例患者术后住院时间分别为12 d、10 d、9 d和6 d。1例发生肝断面积液,经保守治疗吸收治愈;其余3例均无并发症发生。4例患者均获随访,中位随访时间19.5(10.0~24.0)个月,均无结石复发或胆道相关症状。结论 对于符合特定解剖条件的局限于肝Ⅲ段的肝内胆管结石,腹腔镜解剖性肝Ⅲ段切除术安全可行,疗效满意。

以互动达标理论为指导的延续性护理结合家庭参与式护理干预在胆囊结石合并肝外胆管结石行X线下ERCP+LC术后患者中的应用效果

目的探讨以互动达标理论为指导的延续性护理结合家庭参与式护理干预在胆囊结石合并肝外胆管结石行X线下经内镜逆行胰胆管造影术(ERCP)+腹腔镜胆囊切除术(LC)术后患者中的应用效果。方法选取2021年5月至2022年10月收治的120例胆囊结石合并肝外胆管结石行X线下ERCP+LC术后患者作为研究对象,按护理方式差异将其分为对照组和观察组,各60例。对照组采用常规护理干预,观察组在常规护理基础上采用以互动达标理论为指导的延续性护理结合家庭参与式护理干预。比较两组的干预效果。结果干预后,观察组的健康行为能力自评量表(SRAHP)各维度评分高于对照组(P<0.05)。干预后,观察组的恐惧疾病进展简化量表(FoP-Q-SF)各维度评分均低于对照组(P<0.05)。观察组的远期并发症总发生率及结石复发率均低于对照组(P<0.05)。结论以互动达标理论为指导的延续性护理结合家庭参与式护理干预可提高胆囊结石合并肝外胆管结石行X线下ERCP+LC术后患者的健康行为,减轻疾病进展恐惧感,也能降低远期并发症发生率,预防结石复发,值得推广。

不同剂量瑞马唑仑对肝内外胆管结石手术患者麻醉效果及血流动力学影响

目的:探讨不同剂量瑞马唑仑对肝内外胆管结石手术患者麻醉效果及血流动力学的影响。方法:选取103例行肝内外胆管结石手术的患者为研究对象,采用瑞马唑仑麻醉,根据麻醉剂量不同分为低剂量组(0.2 mg/kg,n=52)及高剂量组(0.3 mg/kg,n=51)。比较两组患者麻醉效果、镇痛效果、氧化应激程度、血流动力学及不良反应发生情况。结果:低剂量组拔管时间及苏醒时间均短于高剂量组(P<0.05)。麻醉后,两组患者Ramsay评分均随时间发展而逐渐升高,且低剂量组Ramsay评分在麻醉15 min及麻醉30 min时均低于高剂量组(P<0.05)。术后6、12、24 h,高剂量组VAS评分均低于低剂量组,且两组患者VAS评分均随时间发展呈先升高后下降趋势(P<0.05)。术后1 d,两组患者过氧化氢(H_(2)O_(2))、人皮质醇(Cor)及丙二醛(MDA)水平均高于术前,且低剂量组各指标水平均低于高剂量组(P<0.05)。麻醉后15 min,两组患者舒张压、收缩压及心率水平均升高,高剂量组血氧饱和度降低,且低剂量组舒张压、收缩压及心率低于高剂量组,血氧饱和度高于高剂量组(P<0.05)。两组患者不良反应发生率无统计学差异(P>0.05)。结论:两种剂量瑞马唑仑麻醉均具有较高的麻醉、镇静及镇痛效果,但高剂量麻醉易导致患者血流动力学波动较大,易引起患者产生较大应激反应,因此对于肝内外胆管结石手术采用低剂量麻醉安全性更佳。

肝内胆管结石影响肝内胆管癌患者手术预后的回顾性分析

目的探讨肝内胆管结石(IBDS)对接受根治性手术的肝内胆管细胞癌(ICC)患者的预后影响。方法回顾性分析2010年1月至2022年9月浙江省肿瘤医院收治的204例完成根治性手术的ICC患者的临床资料,根据患者有无IBDS,分为IBDS阴性组(n=179)和IBDS阳性组(n=25),采用Kaplan-Meier法绘制生存曲线并计算累积存活率,Log-rank检验及Cox回归模型评估影响手术预后的因素。结果与IBDS阳性组比较,IBDS阴性组患者1、3、5年生存率分别为73.8%vs 40.0%、52.0%vs 26.7%、34.9%vs 0,中位生存期(OS)为20.2个月vs 10.0个月,1、3、5年的无复发生存率为54.0%vs 20.0%、30.2%vs 15.0%、25.7%vs 0,中位无复发生存期(RFS)为13.1个月vs 7.6个月,差异均有统计学意义(P<0.01)。IBDS阳性组二次分组的生存曲线分析表明,淋巴结转移严重影响IBDS阳性组ICC患者术后的OS(P=0.012),降低了IBDS阳性组ICC患者术后的RFS(P=0.004)。结论IBDS明显降低ICC患者根治性手术的远期效果,淋巴结转移则严重影响IBDS阳性ICC患者的预后;注重IBDS的治疗以及淋巴结转移的预防可能改善ICC患者手术预后。

自制纱布条在降低腹腔镜胆总管探查术治疗肝内胆管结石术后残石率中的应用效果

目的探讨自制纱布条在降低腹腔镜胆总管探查术(LCBDE)治疗肝内胆管结石术后残石率的应用效果。方法选取2020年7月至2023年1月上饶市中心医院普外科收治的40例经计算机断层扫描(CT)、磁共振成像(MRI)、磁共振胰胆管造影(MRCP)确诊为胆总管结石合并肝内胆管多发结石的患者作为研究对象,采用随机数字表法将其分为塞纱布条组和不塞纱布条组,每组各20例。两组患者均进行LCBDE手术治疗,塞纱布条组患者在胆总管结石取干净后,准备进行胆道镜探查治疗肝内胆管结石前,采用自制纱布条对胆总管下段进行填塞,不塞纱布条组则不采用纱布条填塞。比较两组患者治疗情况(手术时间、术后排气时间、经T管胆道镜下碎石取石次数、住院时间);比较术前、术后3 d时两组患者肠道屏障功能水平(D-乳酸、内毒素);比较两组患者术后6个月复查时残石率。结果塞纱布条组手术时间、术后排气时间、住院时间短于不塞纱布条组,经T管胆道镜下碎石取石次数少于不塞纱布条组,差异有统计学意义(P<0.05)。术后3 d,两组患者D-乳酸、内毒素水平高于本组术前,塞纱布条组D-乳酸、内毒素水平低于不塞纱布条组,差异有统计学意义(P<0.05)。术后6个月复查时,塞纱布条组患者残石率低于不塞纱布条组,差异有统计学意义(P<0.05)。结论自制纱布条用于LCBDE治疗肝内胆管结石术中,可有效缩短手术时间,促进患者术后胃肠功能恢复,并有效降低术后的残石率,值得临床推广应用。

双镜联合治疗胆囊结石合并肝外胆管结石患者的疗效及安全性分析

目的对胆囊结石合并肝外胆管结石患者采用双镜联合(腹腔镜联合十二指肠镜)治疗的临床效果和安全性进行分析。方法选择103例胆囊结石合并肝外胆管结石患者,根据手术方案不同分为观察组(61例,行双镜联合下胆囊切除术)和对照组(42例,实施传统开腹手术)。比较两组围术期指标[手术时间、住院时间、出血量、术后视觉模拟评分法(VAS)评分、结石清除率]、血清应激指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、皮质醇(Cor)]、肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转移酶(GGT)]、并发症发生率。结果两组结石清除率均为100.0%,比较无明显差异(P>0.05)。观察组的手术时间(96.3±7.5)min和住院时间(7.5±2.1)d短于对照组的(119.2±10.2)min、(9.4±1.2)d,出血量(25.8±5.4)ml少于对照组的(46.3±6.9)ml,术后VAS评分(2.9±0.8)分低于对照组的(3.4±0.7)分(P<0.05)。术前,两组血清中TNF-α、IL-6、CRP、Cor水平比较无明显差异(P>0.05);术后7 d,两组血清中TNF-α、IL-6、CRP、Cor水平均明显高于术前,但观察组明显低于对照组(P<0.05)。术前,两组的ALT、AST、GGT比较,无明显差异(P>0.05)。术后7 d,观察组的ALT(43.9±4.3)U/L、AST(40.4±4.1)U/L、GGT(154.2±12.9)U/L均低于对照组的(56.9±6.4)、(49.2±5.1)、(193.3±26.5)U/L(P<0.05)。观察组并发症发生率为4.92%,低于对照组的21.43%,差异有统计学意义(P<0.05)。结论胆囊结石合并肝外胆管结石患者治疗中采用双镜联合下胆囊切除术治疗,能够改善围术期各项指标,并使得术后应激反应得到减轻,促进患者的术后恢复,并发症风险也大大降低,因此该方案值得在临床上推广。

老龄胆囊切除术后多发肝外胆管结石患者的内镜及腹腔镜微创治疗疗效分析

目的 比较逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)及腹腔镜胆总管探查(laparoscopic comom bile duct exploration,LCBDE)在老龄胆囊切除术后多发肝外胆管结石中的疗效和并发症发生情况。方法 回顾性分析2019年7月—至2022年10月上海市徐汇区中心医院普外科收治的老龄胆囊切除术后多发肝外胆管结石患者临床资料,根据手术方式分为LCBDE组和ERCP组,比较两组患者的手术相关指标及术后指标。结果 两组患者在性别、年龄、是否合并糖尿病无明显统计学差异,LCBDE治疗组结石最大直径[(13.78±2.52) mm vs(9.38±2.82) mm]及胆总管直径[(14.96±2.50) mm vs(10.86±2.75) mm]均明显大于ERCP治疗组;两组患者均无围手术期死亡,LCBDE治疗组中术后发生A级胆漏1例,2个月后行胆道镜检查结石残留2例,行胆道镜下取石治疗;ERCP治疗组发生高淀粉酶血症3例,B级胰腺炎1例;LCBDE治疗组手术时间[(123.74±26.14) min vs(24.86±5.55)] min、术后肛门通气时间[(62.60±15.71) h vs(24.72±6.46) h]、术后住院时间[(9.40±1.44) d vs(3.55±1.84]) d均明显长于ERCP治疗组;两组术前生化指标无明显统计学差异(P>0.05);LCBDE治疗组术后第1天WBC[(12.29±2.64)×10^(9)/L vs(10.11±2.91)×10^(9)/L]、术后第1天CRP[(51.96±14.70) mg/L vs(36.17±14.04)] mg/L、术后第3天CRP[(23.30±8.20) mg/L vs(15.10±5.85) mg/L]均明显高于ERCP治疗组,两组TBIL、DBIL、ALT无明显统计学差异(P>0.05)。结论 对于老龄胆囊切除术后多发肝外胆管结石的患者,采用LCBDE与ERCP治疗均是安全有效的,ERCP治疗组手术时间短,术后恢复良快,对小直径胆管结石是首选治疗方案。

质量反馈护理模式对肝内胆管结石手术患者的并发症与应激反应的影响

目的分析在肝内胆管结石手术治疗中采取质量反馈护理模式的应用价值及对并发症与应激反应的影响。方法将2022年1月至2023年12月我院接收的120例行肝内胆管结石术治疗的患者作为本次研究对象,以随机数字表法分组,即观察组(质量反馈护理模式,60例)与对照组(常规护理,60例),比较两组护理后护理满意度、并发症发生率(切口感染、胸腔积液、腹腔感染)、恢复时间(术后首次排气时间、排便时间、下床时间、进食时间、切口拆线时间、腹腔引流管拔除时间、术后住院时间),观察两组护理时手术前后应激反应[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)]。结果观察组护理满意度高于对照组(P<0.05);观察组并发症发生率、恢复时间均低于对照组(P<0.05);两组术前应激水平比较无明显差异(P>0.05),术后应激水平状态观察组效果优于对照组(P<0.05)。结论在肝内胆管结石手术治疗中采取质量反馈护理模式可减轻术后应激反应,减少术后并发症的发生,较常规护理模式还可缩短术后恢复时间,提高护理满意度。

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

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。

多镜联合胆管塑料支架置入胆管Ⅰ期缝合在肝外胆管结石中的应用

目的探讨腹腔镜、胆道镜、胃镜联合下胆管塑料支架置入胆管Ⅰ期缝合治疗肝外胆管结石的效果。方法收集2020年1月至2022年12月本院60例肝外胆管结石患者的临床资料。根据不同胆管引流方式将患者分为2组,各30例。观察组应用多镜联合下胆管塑料支架置入胆管Ⅰ期缝合;对照组应用腹腔镜胆总管探查+T管引流。比较两组手术时间、术中失血量、住院时间、治疗周期、住院费用。结果两组均成功完成手术,无中转剖腹。观察组术后住院时间、医疗费用少于对照组(P<0.05);手术时间、术中出血量、术后排气时间、结石清除率比较,差异无统计学意义(P>0.05)。观察组术后并发症总发生率3.33%,对照组16.67%,差异无统计学意义(P>0.05)。结论多镜联合胆管塑料支架置入胆管Ⅰ期缝合治疗肝外胆管结石可缩短住院时间、降低费用,手术安全性高,适宜在基层医院推广。

腹部CT与磁共振胰胆管成像在肝外胆管结石诊断中的应用价值

目的:分析腹部CT与磁共振胰胆管成像在肝外胆管结石诊断中的应用价值。方法:回顾性分析2020年1月—2022年5月郑州市第三人民医院接受诊治的70例疑似肝外胆管结石患者临床资料,对所有患者均进行腹部CT与磁共振胰胆管成像扫描诊断,以手术病理结果为金标准,统计两种诊断方式的诊断效能,统计两种诊断方式对直径<8 mm结石的检出率,记录检查所耗用的时间。结果:以手术病理结果为金标准,70例疑似患者中阳性和阴性分别为67例和3例,腹部CT与磁共振胰胆管成像诊断的符合率分别为53例(75.71%)和65例(92.86%),在诊断效能方面,两种诊断方式的特异度比较,差异无统计学意义(χ^(2)=0,P>0.05);磁共振胰胆管成像诊断的敏感度、准确率均较腹部CT高,差异有统计学意义(χ^(2)=8.873、8.776,P<0.05);磁共振胰胆管成像对直径<8 mm结石检出率较腹部CT高,但是所用的检查时间稍长,差异有统计学意义(χ^(2)=18.746;t=2.613,P<0.05)。结论:临床上对肝外胆管结石患者实施诊断时,应用腹部CT与磁共振胰胆管成像诊断均可,但是相比较而言,磁共振胰胆管成像诊断准确率更高,可为临床治疗提供可靠的指导依据。

完全腹腔镜下左肝蒂阻断行左半肝切除术对肝内外胆管结石患者的疗效分析

目的探讨肝内外胆管结石患者治疗中,相比常规开腹手术,开展左肝蒂阻断法行完全腹腔镜左半肝切除术的应用价值。方法选取2013年1月至2022年12月本院病收治的68例肝内外胆管结石患者为研究对象,基于随机数字表法规范化分为两组各34例,对照组实行常规开腹手术,观察组实行完全腹腔镜下左肝蒂阻断法左半肝切除术,观察对比两组手术相关指标、术后并发症率、肝功能指标、术后疼痛程度、生活质量。结果与对照组做对比,观察组患者术中出血量相对少,手术用时明显短,且术后下床活动、肛门排气及住院的时间均更短(P<0.05);对比术后并发症率计算结果,观察组更低(P<0.05);术后,两组AST、ALT、TBiL水平均升高(P<0.05),且观察组与对照组对比(P>0.05);观察组术后1d、2d、3d的VAS评分较对照组明显低(P<0.05);治疗1个月后,两组SF-36评分均升高,且观察组较对照组更高(P<0.05)。结论左肝蒂阻断法行完全腹腔镜左半肝切除术,用于肝内外胆管结石的治疗中,相较于开腹治疗,可降低手术创伤,加快术后康复,且减小并发症几率并减轻疼痛,取得更为理想的治疗效果,促进患者生活质量全面提升。