腹腔镜联合ERCP对胆总管结石合并肝硬化患者术后早期肝功能的影响研究

目的探讨腹腔镜联合ERCP对胆总管结石合并肝硬化患者术后早期肝功能的影响研究。 方法回顾性分析2015年1月至2018年6月经腹腔镜＋ERCP治疗(联合组)及经开腹手术治疗(开腹组)的胆总管结石合并肝硬化患者各42例临床资料。数据分析用SPSS 19.0软件处理，手术相关指标、术前及术后3 d炎症反应、术前及术后2周肝功能指标以( ±s)表示，采用独立样本t检验；结石清除率、术后并发症采用χ²检验或Fisher精确检验；P<0.05为差异有统计学意义。 结果两组手术时间比较，差异无统计学意义(P>0.05)，腔镜＋ERCP组术中出血量、术后住院时间及术后并发症总发生率明显低于开腹组(P<0.05)。术后3 d时，两组炎症反应(PCT、CRP、IL－6)均较术前升高(P<0.05)，且开腹组高于联合组(P<0.05)；两组肝功能指标(Child－Pugh评分、MELD评分、MELD－Na评分)均较术前降低(P<0.05)，且联合组低于开腹组(P<0.05)。 结论腹腔镜＋ERCP对胆总管结石合并肝硬化患者治疗效果较好，能降低手术创伤，减轻炎症反应，降低术后并发症，缓解患者术后肝功能损伤有积极意义。

Postoperative early period liver function of patients with choledocholithiasis and cirrhosis after laparoscopic and ERCP treatment

ObjectiveTo investigate the postoperative early period liver function of patients with choledocholithiasis and cirrhosis after laparoscopic and ERCP treatment. MethodsFrom January 2015 to June 2018, clinical data of 42 patients with choledocholithiasis and cirrhosis treated by laparoscopy plus ERCP(combined group) or laparotomy (open group) were analyzed retrospectively. SPSS 19.0 software was used for data analysis. Measurement data such as surgical indicators, inflammatory response and liver functions were expressed as ( ±s) and were examined by independent t test. The Calculi clearance rate and postoperative complications were examined by chi square test or Fisher exact test. A P value of <0.05 was considered as statistically significant. ResultsThere was no significant difference in operation time between the two groups (P>0.05). The intraoperative blood loss, postoperative hospitalization time and the total incidence of postoperative complications in the combined group were significantly lower than those in the open group respectively (P<0.05). At 3 days after operation, the inflammatory reaction (PCT, CRP, IL-6) of the two groups were all increased, while more change in open group (P<0.05). The indexes of liver function (Child-Pugh score, MELD score and MELD-Na score) of the two group were decreased after operation (P<0.05), while less change in combined group (P< 0.05). ConclusionLaparoscopy + ERCP has a better therapeutic effect of patients with choledocholithiasis and liver cirrhosis, which could reduce surgical trauma, inflammatory reaction, postoperative complications and could alleviate postoperative liver function injury.