腹腔镜超声手术探查对复杂肝内胆管结石患者的临床应用研究

目的探讨腹腔镜超声手术探查对复杂肝内胆管结石患者的临床应用价值,寻找一种更为安全有效的治疗术式。方法回顾性分析黑龙江省医院2017年1月至2019年11月收治的101例复杂肝内胆管结石患者临床资料,患者均进行腹腔镜肝切除术治疗,且术中均实施腹腔镜超声手术探查。分析各项围手术期指标、术后并发症发生情况、中转开腹、入住ICU以及结石复发情况。对比患者手术前后血清丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、天冬氨酸氨基转移酶(AST)、谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)水平。结果手术时间为(188.23±54.29)min,术中失血量(210.30±98.74)ml,术后引流时间(3.48±0.91)d,术后住院时间(5.21±1.05)d,结石残留率1.98%(2/101)。患者中转开腹率3.96%(4/101),入住ICU及结石复发人数占比分别为20.79%(21/101)、3.96%(4/101)。术后7例(6.93%)出现并发症,包括2例胆漏,3例术后出血,2例腹腔感染,无肺部感染病例。患者术后血清ALT、AST、GGT、ALP水平明显低于术前,而ALB水平明显高于术前(P<0.05)。结论腹腔镜超声手术探查应用于复杂肝内胆管结石患者的效果较佳,可促进患者早日康复,降低术后并发症发生风险,值得临床推广应用。

Clinical application of laparoscopic ultrasonography in patients with complex intrahepatic bile duct stones

Objective To study and analyze the clinical application value of laparoscopic ultrasonography in patients with complex intrahepatic bile duct stones,in order to provide a more safe and effective treatment for this disease.Methods The clinical data of 101 patients with complex intrahepatic bile duct stones admitted to Heilongjiang Hospital from January 2017 to November 2019 were retrospectively analyzed.All the patients were treated with laparoscopic hepatectomy,and underwent laparoscopic ultrasonic surgical exploration during the operation.The perioperative indicators,postoperative complications,conversion to laparotomy,admission to ICU and stone recurrence were analyzed.Serum ALT,ALB,AST,GGT and ALP levels of the patients before and after operation were compared.Results The operative time was(188.23±54.29)min,the intraoperative blood loss was(210.30±98.74)ml,the postoperative drainage time was(3.48±0.91)d,the postoperative hospital stay was(5.21±1.05)d,and the residual stone rate was 1.98%(2/101).The transfer rate of patients to laparotomy was 3.96%(4/101),and the proportion of patients admitted to ICU and recurrence of stones was 20.79%(21/101)and 3.96%(4/101),respectively.Complications occurred in 7 patients,accounting for 6.93%,including 2 cases of biliary leakage,3 cases of postoperative hemorrhage,2 cases of abdominal infection,and no pulmonary infection.Postoperative serum ALT,AST,GGT and ALP level were significantly lower than those before surgery,while ALB level was significantly higher than that before surgery(P<0.05).Conclusion The application of laparoscopic ultrasonography in patients with complex intrahepatic bile duct stones can promote the early recovery of patients,reduce the risk of postoperative complications,and is worthy of clinical application.