摘要
目的对比经皮肝胆道造瘘碎石取石术(PTCSL)与传统开腹肝段切除术(OH)对区域性肝胆管结石合并胆汁性肝硬化的治疗效果。方法回顾性收集2020年1月至2022年8月湖南省人民医院肝胆外科收治并行手术治疗的区域性肝胆管结石合并胆汁性肝硬化的病例110例。根据治疗肝胆管结石的手术方式分为微创组和开腹组,微创组行PTCSL,开腹组行OH。对两组的临床资料进行比较分析,观察术后排气时间、胃肠功能恢复时间、手术时间及术中出血量,对比两组手术前后丙氨酸转氨酶(ALT)、γ-谷氨酰转移酶(GGT)及天冬氨酸转氨酶(AST)水平。统计两组并发症发生率、结石取净率。结果微创组患者术后排气时间[(11.12±2.09)h]、胃肠功能恢复时间[(25.76±4.28)h]、手术时间[(108.51±16.19)h]及术中出血量[(20.16±3.59)ml]少于开腹组[术后排气时间(29.35±4.83)h、胃肠功能恢复时间(36.91±6.35)h、手术时间(116.27±21.54)h及术中出血量(38.03±6.22)ml](均P<0.05)。微创组患者手术后ALT[(77.82±16.25)U/L]、GGT[(248.16±24.83)U/L]及AST[(65.42±16.82)U/L]水平低于开腹组[ALT(102.37±25.64)U/L、GGT(345.45±32.60)U/L及AST(96.30±22.17)U/L](均P<0.05)。微创组术后并发症发生率7.27%(4/55),开腹组术后并发症发生率29.09%(16/55),差异具有统计学意义(P<0.05);微创组结石取尽率61.82%(34/55),开腹组结石取尽率92.73%(51/55),差异具有统计学意义(P<0.05)。结论PTCSL与OH对区域性肝胆管结石合并胆汁性肝硬化进行治疗均有效,OH取石率高,PTCSL对肝功能影响小,并发症发生率小,术后恢复快。
Objective To compare the therapeutic effects of percutaneous transhepatic choledochoscopic lithotripsy(PTCSL)and traditional open hepatectomy(OH)on regional hepatolithiasis with biliary cirrhosis.Methods From January 2020 to August 2022,110 cases of regional hepatolithiasis complicated with biliary cirrhosis treated in the hepatology department of Hunan Provincial People's Hospital were retrospectively collected.According to the surgical methods of treating hepatolithiasis,the patients were divided into minimally invasive group and laparotomy group.The minimally invasive group received PTCSL,and the laparotomy group received OH.The clinical data of the two groups were compared and analyzed,and the postoperative exhaust time,gastrointestinal function recovery time,operation time and intraoperative bleeding volume were observed.The levels of alanine aminotransferase(ALT),γ-glutamyltransferase(GGT)and aspartate aminotransferase(AST)before and after operation were compared between the two groups.The incidence of complications and stone removal rate of the two groups were recorded.Results The postoperative exhaust time(11.12±2.09)h,gastrointestinal function recovery time(25.76±4.28)h,operation time(108.51±16.19)h,intraoperative blood loss(20.16±3.59)ml and postoperative exhaust time(29.35±4.83)h and gastrointestinal function recovery time in the minimally invasive group were less than those in the laparotomy group(36.91±6.35)h,operation time(116.27±21.54)h and intraoperative blood loss(38.03±6.22)ml(all P<0.05).The levels of ALT(77.82±16.25)U/L,GGT(248.16±24.83)U/L and AST(65.42±16.82)U/L in the minimally invasive group after operation were lower than those in the laparotomy group[ALT(102.37±25.64)U/L,GGT(345.45±32.60)U/L and AST(96.30±22.17)U/L](all P<0.05).The incidence of postoperative complications was 7.27%(4/55)in the minimally invasive group and that in the laparotomy group was 29.09%(16/55),with statistically significant difference(P<0.05).The stone removal rate was 61.82%(34/55)in the minimally invasive group and 92.73%(51/55)in the laparotomy group,with statistically significant difference(P<0.05).Conclusions PTCSL and OH are effective in the treatment of regional hepatolithiasis complicated with biliary cirrhosis.The traditional OH has a high stone removal rate,and PTCSL has little influence on liver function,small complication rate and fast postoperative recovery.
作者
彭江
连博达
汪新天
陈晨
何自力
Peng Jiang;Lian Boda;Wang Xintian;Chen Chen;He Zili(Five wards of Hepatology Department,Hunan People's Hospital(The First Affiliated Hospital of Hunan Normal University),Changsha 410000,China)
出处
《中国医师杂志》
CAS
2023年第2期192-195,201,共5页
Journal of Chinese Physician
基金
湖南省教育厅科研计划项目(19C1183)
长沙市科技局项目(2020SCZ001)。
