腹腔镜规则性肝段或肝叶切除治疗复杂性肝内胆管结石患者血浆皮质醇和外周血T淋巴细胞亚群的变化*

doi:10.3969/j.issn.1672-5069.2020.01.033

摘要/Abstract

摘要： 目的探究完全腹腔镜手术治疗成人先天性胆总管囊肿的疗效及安全性。方法回顾性分析2012年2月~2018年5月在我院进行手术治疗的25例先天性胆总管囊肿患者的临床资料,其中接受传统开腹手术治疗者17),采用完全腹腔镜手术治疗者8例。结果开腹组患者术后首次进食时间、肛门排气时间、排便时间、住院日和术中出血量分别为(5.0±1.7) d、(3.8±1.5)d、(4.7±1.8) d、(9.4±2.3) d和(241.6±15.3)mL,显著长于或多于腔镜组【分别为(3.0±1.1) d、(2.6±0.8) d、(3.1±1.3) d、(6.6±1.2) d和(94.0±9.7)mL,P<0.05】,但腔镜组手术时间为(278.3±60.5)min,显著长于开腹组【(231.7±41.2)min,P<0.05】;治疗后3 d,开腹组患者血清C反应蛋白(CRP)水平为(77.4±6.4)mg/L ,显著高于腔镜组【(30.8±3.5)mg/L,P<0.05】;腔镜组和开腹组手术后并发症发生率分别为37.5%和58.8%,无显著性差异(P>0.05)。结论完全腹腔镜手术治疗成人先天性胆总管囊肿患者疗效较好,与传统开腹手术比,术中出血量少,术后恢复快,不加重肝功能损伤。

关键词: 复杂性肝内胆管结石, 腹腔镜手术, 规则性肝段或肝叶切除术, 皮质醇, 淋巴细胞亚群

Abstract: Objective The aim of this study was to explore the efficacy and safety of laparoscopic surgery in treatment of adult patients with congenital choledochal cyst (CCC). Methods The clinical data of 25 patients with CCC in our hospital between February 2012 and May 2018 were analyzed retrospectively. 17 patients received traditional open operation, and 8 received total laparoscopic surgery. Results The first feeding time, postoperative anal exhaust time, postoperative defecation time, hospital stay and intraoperative bleeding in patients with open surgery were (5.0±1.7) d, (3.8±1.5) d,(4.7±1.8) d, (9.4±2.3) d and (241.6±15.3)mL, significantly longer or greater than 【(3.0±1.1) d, (2.6±0.8) d, (3.1±1.3) d, (6.6±1.2) d and (94.0±9.7)mL, respectively, P<0.05】 in patients with laparoscopic surgery, while the operation time was (278.3±60.5)min, much longer than 【(231.7±41.2)min, P<0.05】 in patients with open surgery; 3 days after operation, serum C reactive protein level in patients with open surgery was (77.4±6.4)mg/L, significantly higher than 【(30.8±3.5)mg/L, P<0.05】 in patients with laparoscopic surgery; the total incidences of complications after operation were 37.5% and 58.8% in the two groups, no significant difference (P>0.05). Conclusion As compared with traditional open operation, the laparoscopic surgery is efficacious in dealing with patients with adult CCC, which might reduce the inflammatory response and intraoperative bleeding, and promote postoperative recovery.

Key words: Complex intrahepatic bile duct stone, Laparoscopic regular hepatectomy or lobectomy, Blood cortsisol, Peripheral blood T lymphocyte subsets

钱国武, 崔广莹, 宋展, 吕柯, 刘驰, 孙万日. 腹腔镜规则性肝段或肝叶切除治疗复杂性肝内胆管结石患者血浆皮质醇和外周血T淋巴细胞亚群的变化^*[J]. 实用肝脏病杂志, 2020, 23(1): 122-125.

Qian Guowu, Cui Guangying, Song Zhan, et al. Changes of blood cortsisol and peripheral blood T lymphocyte subsets in patients with complicated intrahepatic bile duct stones after laparoscopic regular hepatectomy or lobectomy[J]. Journal of Practical Hepatology, 2020, 23(1): 122-125.

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腹腔镜规则性肝段或肝叶切除治疗复杂性肝内胆管结石患者血浆皮质醇和外周血T淋巴细胞亚群的变化^*

Changes of blood cortsisol and peripheral blood T lymphocyte subsets in patients with complicated intrahepatic bile duct stones after laparoscopic regular hepatectomy or lobectomy

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