胆道镜取石联合腹腔镜左半肝切除术对复杂肝内胆管结石患者应激指标和结石清除率的影响

Effects of choledochoscopic lithotomy combined with laparoscopic left hemihepatectomy on stress indexes and stone clearance in patients with complex intrahepatic biliary stones

摘要:

目的 评估胆道镜联合腹腔镜左半肝切除术对复杂肝内胆管结石患者应激反应和结石清除率的影响。方法 回顾性分析2020年6月－2024年6月该院194例复杂肝内胆管结石患者的临床资料，按手术方式不同，将患者分为对照组（n = 97）和观察组（n = 97）。对照组采用腹腔镜左半肝切除术，观察组采用胆道镜取石联合腹腔镜左半肝切除术。比较两组患者术前和术后3 d的应激指标［皮质醇（Cor）和肾上腺素（AD）］、炎症因子［C反应蛋白（CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）］和术后恢复情况。比较两组患者术前和术后7 d肝功能指标［丙氨酸转氨酶（ALT）、总胆红素（TBiL）和谷氨酰转移酶（GGT）］的差异。评估两组患者术后3个月的治疗效果。记录并比较两组患者术后并发症的发生率（胆漏、感染、结石残留和胸腔积液）。结果 术前和术后3 d，两组患者Cor、AD、CRP、IL-6和TNF-α水平比较，差异均无统计学意义（P > 0.05），但两组患者以上指标术后较术前明显升高，差异均有统计学意义（P < 0.05）。术前，两组患者ALT、TBiL和GGT比较，差异均无统计学意义（P > 0.05）。术后7 d，两组患者ALT、TBiL和GGT明显下降，且观察组明显低于对照组，差异均有统计学意义（P < 0.05）。两组患者术后24 h视觉模拟评分法（VAS）、术后肛门排气时间和术后自主下床活动时间比较，差异均无统计学意义（P > 0.05），观察组住院时间明显短于对照组，差异有统计学意义（P < 0.05）。观察组术后3个月的治疗效果明显优于对照组，差异有统计学意义（P < 0.05）。观察组术后并发症的总发生率明显低于对照组，差异有统计学意义（P < 0.05）。结论 胆道镜联合腹腔镜左半肝切除术治疗复杂肝内胆管结石的效果显著，对患者应激反应的影响较小，有助于患者术后肝功能的恢复，减少并发症发生风险。

Abstract:

Objective This research assessed the impact of incorporating choledochoscopy with laparoscopic left hepatectomy on stress response and bile duct stone removal in patients presenting with complex intrahepatic biliary stones.Methods Clinical data of 194 patients with complex intrahepatic biliary stones from June 2020 to June 2024 were retrospectively analyzed. The patients were divided into control group (n = 97) and observation group (n = 97) according to different operation methods. The control group received laparoscopic left hepatectomy, while the observation group received choledochoscopic lithotomy combined with laparoscopic left hepatectomy. The changes of stress indexes [cortisol (Cor), adrenaline (AD)], inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] in the two groups before and 3 days after operation were compared. The liver function indexes [alanine transaminase (ALT), total bilirubin (TBiL), glutamyl transferase (GGT)] of the two groups before and 7 days after operation were compared. The treatment effect levels of the two groups were evaluated 3 months after operation. The incidence of postoperative complications (bile leakage, infection, residual stones and pleural effusion) was recorded and compared between the two groups.Results Three days before and after operation, the levels of Cor, AD, CRP, IL-6 and TNF- α in the two groups had no significant difference (P > 0.05), but the postoperative level in two groups were significantly higher than those before surgery, and the differences were statistically significant (P < 0.05). Before operation, there was no significant difference in ALT, TBiL and GGT between the two groups (P > 0.05). On the 7th day after operation, ALT, TBiL and GGT of the two groups decreased, and the observation group was lower than those of the control group (P < 0.05). There was no significant difference in visual analogue scale (VAS), postoperative anal exhaust time and postoperative ambulation time between the two groups (P > 0.05). The hospitalization time of the observation group was shorter than that of the control group, the difference was statistically significant (P < 0.05). The therapeutic effect of the observation group at 3 months after operation was significantly better than that of the control group, the difference was statistically significant (P < 0.05). The total incidence of postoperative complications in the observation group was significantly lower than that in the control group, the difference was statistically significant (P < 0.05).Conclusion The combination of laparoscopic left hepatectomy and choledochoscopy effectively addresses complex intrahepatic biliary stones, minimally impacting patient stress responses, enhancing liver function, and reducing complication risks, thereby holding promising clinical applicability.