摘要
目的:观察左肝蒂阻断法行完全腹腔镜左半肝切除术治疗肝内外胆管结石患者的效果。方法:选取2018年1月至2021年12月该院收治的80例肝内外胆管结石患者进行前瞻性研究,按照随机数字表法将其分为对照组与观察组各40例。观察组采用左肝蒂阻断法行完全腹腔镜左半肝切除术治疗,对照组采用开腹左半肝切除术治疗。比较两组围术期指标[手术时间、术中出血量、肛门排气时间、首次下床活动时间、住院时间和术后1 d视觉模拟评分法(VAS)评分]水平,手术前后肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、谷氨酰转移酶(GGT)]水平、应激指标[肾上腺素(E)、皮质醇(Cor)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平,以及并发症发生率。结果:观察组手术时间长于对照组,术中出血量少于对照组,术后1 d VAS评分低于对照组,肛门排气时间、首次下床活动时间和住院时间均短于对照组,差异有统计学意义(P<0.05);术后7 d,两组ALT、AST、TBIL、GGT水平均低于术前,但组间比较,差异均无统计学意义(P>0.05);术后3 d,两组E、Cor、CRP、IL-6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2.50%(1/40),低于对照组的20.00%(8/40),差异有统计学意义(P<0.05)。结论:左肝蒂阻断法行完全腹腔镜左半肝切除术治疗肝内外胆管结石患者可减少术中出血量,缩短肛门排气时间、首次下床活动时间和住院时间,降低术后VAS评分、应激指标水平和并发症发生率,效果优于开腹左半肝切除术治疗,但需延长手术时间。
Objective:To observe effects of total laparoscopic left hemihepatectomy with left hepatic pedicle occlusion in treatment of patients with intrahepatic and extrahepatic bile duct stones.Methods:A prospective study was conducted on 80 patients with intrahepatic and extrahepatic bile duct stones admitted to the hospital from January 2018 to December 2021.According to the random number table method,they were divided into control group and observation group,40 cases in each group.The observation group was treated with total laparoscopic left hemihepatectomy with left hepatic pedicle occlusion,while the control group was treated with open left hemihepatectomy.The perioperative indexes[operation time,intraoperative blood loss,anal exhaust time,first ambulation time,hospitalization time and visual analogue scale(VAS)score 1 day after the surgery],the liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),glutamyltransferase(GGT)]and the stress indexes[epinephrine(E),cortisol(Cor),C-reactive protein(CRP),interleukin-6(IL-6)]levels before and after the surgery,and the incidence of complications were compared between the two groups.Results:The operation time of the observation group was longer than that of the control group,the intraoperative blood loss was less than that of the control group,the VAS score 1 d after the surgery was lower than that of the control group,the anal exhaust time,the first ambulation time and the hospitalization time were shorter than those of the control group,and the differences were statistically significant(P<0.05).7 days after the surgery,the levels of ALT,AST,TBIL,and GGT in both groups were lower than before the surgery,but there were no statistically significant differences between the two groups(P>0.05).3 days after the surgery,the levels of E,Cor,CRP and IL-6 in the two groups were higher than those before the surgery,but those in the observation group were lower than those in the control group,and the differences were statistically sig
作者
贾振飞
李少华
王嘉毅
JIA Zhenfei;LI Shaohua;WANG Jiayi(Department of Hepatobiliary and Pancreatic Surgery of Anyang People’s Hospital,Anyang 455000 Henan,China)
出处
《中国民康医学》
2023年第20期57-60,共4页
Medical Journal of Chinese People’s Health
关键词
左肝蒂阻断法
腹腔镜
开腹
左半肝切除术
肝内外胆管结石
肝功能
应激指标
Left hepatic pedicle occlusion method
Laparoscopy
Open
Left hemihepatectomy
Intrahepatic and extrahepatic bile duct stone
Liver function
Stress index
