规则性肝叶切除治疗复杂性肝内胆管结石患者疗效研究

目的 比较采取规则性肝叶切除与非规则性肝叶切除治疗复杂性肝内胆管结石患者的疗效。方法 2019年1月～2020年6月我院收治的298例复杂性肝内胆管结石患者,其中139例接受规则性肝叶切除术,另159例接受不规则性肝叶切除术,术后随访6个月。采用ELISA法或双抗体夹心免疫发光法检测血清白细胞介素-6(IL-6)、降钙素原(PCT)和C反应蛋白(CRP)。结果 观察组手术时间为(121.3±25.2)min,显著长于对照组【(116.7±22.8)min,P＜0.05】,而术中出血量、肛门排气和住院时间分别为(252.3±60.0)mL、(18.9±3.2)h和(11.2±2.3)d,均显著少于或短于对照组【分别为(301.7±70.2)mL、(20.1±4.1)h和(14.5±3.5)d,P＜0.05】;在术后7 d,观察组血清CRP、IL-6和PCT水平分别为(23.8±6.0)mg/L、(80.8±10.1)μg/L和(1.4±0.5)ng/mL,显著低于对照组【分别为(27.9±6.8)mg/L、(96.7±11.3)μg/L和(1.8±0.4)ng/mL,P＜0.05】;观察组血清ALB水平为(34.1±2.9)g/L,显著高于对照组【(32.5±2.7)g/L,P＜0.05】;在随访6个月末,观察组患者出现切口感染、胆漏、胆道出血和胸腔积液并发症发生率为7.9%,显著低于对照组的15.7%(P＜0.05】,观察组结石复发率为11.5%,显著低于对照组的23.9%(P＜0.05)。结论 采取规则性肝叶切除治疗复杂性肝内胆管结石患者可能更有利于患者康复,减少并发症的发生,其效果还需要进一步观察。

Short-term efficacy of regular hepatic lobectomy in patients with complicated hepatolithiasis

Objective The aim of this study was to observe the short-term efficacy of regular hepatic lobectomy in patients with complicated hepatolithiasis. Methods 298 patients with complicated hepatolithiasis were admitted to our hospital between January 2019 and June 2020, and 139 patients underwent regular (observation) and another 159 patients underwent irregular (control) hepatic lobectomy. All patients were followed up for 6 months after surgery. Serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP)] levels were detected by enzyme-linked immunosorbent assay or double antibody sandwich immunoluminescence. Results The operation time in observation group was significantly longer than that in control group [(121.3±25.2) min vs. (116.7±22.8) min, P<0.05], while intraoperative blood loss, anal exhaust time and hospital stay were significantly less or shorter than those in the control group [(252.3±60.0) mL, (18.9±3.2) h and (11.2±2.3) d vs. (301.7±70.2) mL, (20.1±4.1) h and (14.5±3.5) d, respectively, P<0.05]; at the end of seven days after surgery, serum CRP, IL-6 and PCT levels in the observation group were (23.8±6.0) mg/L, (80.8±10.1) μg/L and (1.4±0.5) ng/mL, all significantly lower than those in the control group [(27.9±6.8) mg/L, (96.7±11.3) μg/L and (1.8±0.4) ng/mL, respectively, P<0.05]; serum albumin level was significantly higher than that in the control group [(34.1±2.9) g/L vs. (32.5±2.7) g/L, P<0.05]; at the end of six month follow-up, the incidence rate of complications, such as incision infection, bile leakage, biliary hemorrhage and pleural effusion in observation group was 7.9%, significantly lower than 15.7% in the control group (P＜0.05), and the recurrence rate of intrahepatic stone was 11.5%, significantly lower than 23.9%(P＜0.05) in the control. Conclusion The application of regular hepatic lobectomy isefficacious in treating patients with complicated hepatolithiasis, which might lead to less inflammatory reactions, and needs further and long-term observation.