腹腔镜解剖性肝左外叶切除术治疗肝内胆管结石临床研究.docVIP

腹腔镜解剖性肝左外叶切除术治疗肝内胆管结石临床研究 　　【摘要】 目的：研究肝?鹊ü芙崾?患者采用腹腔镜解剖性肝左外叶切除术的临床治疗效果。方法：选取本院2014年1月-2016年1月收治的83例肝内胆管结石患者作为研究对象，按患者手术意愿分为两组，其中46例患者采用腹腔镜解剖性肝左外叶切除术治疗作为腹腔镜组，另37例患者采用开腹解剖性肝左外叶切除术治疗作为开腹组。观察两组患者治疗效果、手术情况、术后恢复情况、应激反应情况以及并发症情况等。结果：腹腔镜组患者切口长度明显短于开腹组（P0.05），术中出血量两组患者比较差异也无统计学意义（P0.05）。腹腔镜组患者术后排气时间、术后下床时间、饮食恢复时间、住院时间以及住院费用均少于开腹组（P0.05）；术后腹腔镜组患者肾上腺素、皮质醇、IL-6以及CRP水平均明显低于开腹组，而NK细胞水平明显高于开腹组（P0.05）。两组患者并发症包括胆漏、肺部感染以及切口感染，腹腔镜组、开腹组发生率分别为8.70%、21.62%，腹腔镜组明显较低（P0.05）。结论：腹腔镜解剖性肝左外叶切除术对肝内胆管结石的患者治疗效果较佳，手术创伤小，患者术后恢复良好，不良反应少，安全性高，值得临床应用及推广。 　　【关键词】 解剖性； 肝内胆管结石； 血液流变学； 影响 　　【Abstract】 Objective：To study the clinical effect of laparoscopic anatomical extrahepatic left lobectomy on patients with hepatolithiasis. Method：83 cases with hepatolithiasis admitted to our hospital from January 2014 to January 2016 were selected as the research objects， according to the patients’ intention for operation，they were divided into laparoscope group of 46 patients were treated with laparoscopic anatomical liver external left lobectomy，and the other 37 patients were treated with laparotomy anatomical liver external left lobectomy as laparotomy group.The treatment effect，operation condition，postoperative recovery，stress reaction and complications of patients in two groups were observed.Result：The incision length of patients in laparoscope group were significantly shorter than that of laparotomy group（P0.05），the bleeding volume of patients in two groups was not statistically significant（P0.05）.The postoperative evacuation time， bed time， diet recovery time， hospitalization stay， and hospitalization costs for patients in laparoscope group were all less than those of laparotomy group（P 　　【Key words】 Anatomical； Hepatolithiasis； Hemorheology； Influence 　　First-author’s address：The School of Public Health，Guangdong Pharmaceutical University，Guangzhou 510000，China 　　doi：10.3969/j.issn.1674-4985.2017.04.014 　　肝内胆管结石是临床肝胆外科常见的疾病之一，属于难治性胆道疾病，在临床上其发病率占所有结石的10%[1-2]。对于结石患者，临床上通常采用手术治疗具有良好效果，但由于肝内胆管的特殊性解剖结构，使肝内胆