胆总管结石患者再次手术中腹腔镜的应用价值及对肝功能的影响

摘要

目的：探讨胆总管结石患者再次手术中腹腔镜的应用价值以及对肝功能的影响。方法选取2013年9月至2014年8月谷城县中医院接诊的再次手术的胆总管结石患者90例，按照随机数字表法分为观察组和对照组，各45例。观察组采用腹腔镜胆总管切开取石手术，对照组采用常规手术，对比观察两组患者手术情况、肝功能相关指标的变化以及术后病情复发率情况。结果术后，两组胆总管结石患者的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）均有所上升，但观察组显著低于对照组[（131±10） U／L比（142±8） U／L，（137±9） U／L比（145±12） U／L）；白蛋白（ALB）有所下降；但观察组高于对照组[（39±5） g／L比（35±4） g／L]，差异有统计学意义（P＜0.05）；术后，观察组IgA、IgG以及IgM 指标水均有明显下降，但观察组显著高于对照组[（1.73±0.14） g／L比（1.47±0.12） g／L，（7.8±2.1） g／L比（5.8±1.0） g／L，（1.05±0.19） g／L比（0.98±0.11） g／L]，差异有统计学意义（ P ＜0.05）；观察组手术时间、住院时间显著短于对照组[（112±10） min 比（118±16） min、（6±2） d 比（14±3） d]；观察组术中出血量显著低于对照组[（36±5） mL 比（89±2） mL]，差异有统计学意义（P＜0.05）；观察组结石残留发生率和复发率显著低于对照组[11.11％（5／40）比40.00％（18／40）；2.22％（1／40）比13.33％（6／40）]，差异有统计学意义（P ＜0.05）。结论腹腔镜是治疗胆总管结石患者的有效措施，能降低结石残留率，对肝功能以及免疫功能影响小，病情复发率低，值得临床推广。%Objective To evaluate the value of the common bile duct stones in patients laparoscopic reoperation and the impact on liver function .Methods Total of 90 patients with choledocholithiasis receiv-ing reoperation in Gucheng County Hospital of Traditional Chinese Medicine from Sep.2013 to Aug. 2014.The patients were divided into observation group and control group according to random number table method,45 cases each.The observation group received laparoscopic common bile duct stone removal surgery , and the control group received conventional surgery.The surgery condition,the relevant liver function indica-tors changes and relapse rate after surgery of the two groups were observed and compared .Results After surgery,the alanine aminotransferase (ALT),aspartate aminotransferase (AST) were on the rise,but the observation group was significantly lower than the control group [ ( 131 ±10 ) U/L vs ( 142 ±8 ) U/L, (137 ±9) U/L vs (145 ±12) U/L];albumin (ALB) declined,but the observation group was higher than the control group[ (39 ±5) g/L vs (35 ±4) g/L,P<0.05];postoperative IgA,IgG and IgM index levels of the observation group decreased,but higher than the control group [(1.73 ±0.14) g/L vs (1.47 ± 0.12) g/L,(7.8 ±2.1) g/L vs (5.8 ±1.0) g/L,(1.05 ±0.19) g/L vs (0.98 ±0.11) g/L,P <0.05]; operative time,blood loss and length of hospital stay of the observation group were significantly shor-ter/lower than the control group[(112 ±10) min vs (118 ±16) min,(36 ±5) mL vs (89 ±2) mL,(6 ± 2) d vs (14 ±3) d,P<0.05]; residual stones rate and the recurrence rate of the observation group was lower than the control group[11.11%(5/40) vs 40.00%(18/40),2.22%(1/40)vs 13.33%(6/40), P<0.05 ] .Conclusion Laparoscopic treatment for choledocholithiasis patients is effective , which can reduce the rate of residual stones,with small influence on liver function and immune function ,low disease recurrence rate,thus is worthy of promotion in clinical.