关键词: 肝内胆管结石, 腹腔镜肝切除术, 经皮经肝穿刺胆道镜取石术, 治疗

Abstract: Objective The aim of this study was to compare the clinical efficacy of laparoscopic hepatectomy (LH) and percutaneous transhepatic choledochoscopic lithotomy (PTCL) in the treatment of patients with intrahepatic bile duct stones. Methods 86 patients with intrahepatic bile duct stones were enrolled in our hospital between June 2019 and June 2022, and among them, 41 patients in observation group underwent LH and 45 patients in control group underwent PTCL. Serum cortisol (COR) and epinephrine (EP) levels were detected by chemiluminescence. All patients after operation were followed-up by ultrasonography. Results The surgical time, intraoperative blood loss, anal exhaust time and postoperative hospital stay in the observation group were(152.1±21.9)min,(93.2±18.3)ml,(1.2±0.6)d and (4.6±0.8)d, all significantly shorter or less than [(181.6±26.3)min, (149.6±20.1) ml, (1.7±0.8)d and (6.9±1.2)d, respectively, P<0.05] in the control; 3 days after operation, serum ALT, AST, total bilirubin, COR and EP levels in the observation group were (42.8±6.4)U/L, (35.6±5.1)U/L, (16.6±2.1)μmol/l, (359.2±34.4)nmol/ml and (253.2±24.6)pg/ml, all significantly lower than [(56.5±6.7)U/L, (45.8±5.9)U/L, (24.8±2.6)μmol/l, (472.6±41.3)nmol/ml and (316.8±30.3)pg/ml, respectively, P<0.05] in the control; after operation, the incidences of complications, such as infection, ascites, bile leak and bleeding, in the observation was 9.8%, much lower than 26.7%(P<0.05) in the control; 3 months after operation, the residual or relapse of stones revealed by ultrasonography in the observation was 2.4%, much lower than 15.6%(P<0.05) in the control. Conclusion The application of LH in the treatment of patients with intrahepatic bile duct stones is efficacious, which has less post-operational complications and less relapse of stones.

Key words: Choledocholithiasis, Laparoscopic hepatectomy, Percutaneous transhepatic choledochoscopic lithotomy, Therapy