腹腔镜下规则性肝段或肝叶切除术治疗复杂性肝内胆管结石患者疗效再研究

doi:10.3969/j.issn.1672-5069.2021.01.034

摘要/Abstract

摘要： 目的比较腹腔镜下与开腹规则性肝段或肝叶切除术治疗复杂性肝内胆管结石(IHS)患者的疗效及血清Junus激酶蛋白2(JAK2)、信号转导及转录激活因子3(STAT3)和单核细胞趋化蛋白1(MCP-1)的变化。方法 2017年1月～2020年1月我院肝胆外科收治的复杂性IHS患者,53例对照组患者接受开腹规则性肝段或肝叶切除术治疗,58例观察组患者接受腹腔镜下规则性肝段或肝叶切除术治疗。采用ELISA法检测血清JAK2、STAT3和MCP-1水平。结果观察组术中结石清除率为91.4%,显著高于对照组的77.4%(P<0.05),最终结石清除率为98.3%,显著高于对照组的88.7%(P<0.05);观察组手术时间为(2.1±0.7)h,显著短于对照组【(3.4±1.2)h,P<0.05】,下床活动时间为(1.7±0.5)d,显著短于对照组【(3.6±0.8)d,P<0.05】,开始进食时间为(2.6±0.9)d,显著短于对照组【(4.5±1.5)d,P<0.05】,术后住院时间为(3.8±2.6)d,显著短于对照组【(9.2±4.4)d,P<0.05】;在术后3 d,观察组血清白介素-6(IL-6)水平为(81.5±9.6)pg/mL,显著低于对照组【(173.8±14.3)pg/mL,P<0.05】,血清C-反应蛋白(CRP)水平为(59.3±7.5) mg/L,显著低于对照组【(91.4±11.7)mg/L,P<0.05】,血清降钙素原(PCT)水平为(0.41±0.03)μg/L,显著低于对照组【(0.67±0.05)μg/L,P<0.05】;血清JAK2水平为(24.8±6.1)pg/mL,显著低于对照组【(29.2±6.7)pg/mL,P<0.05】,血清STAT3水平为(152.2±16.1)ng/L,显著低于对照组【(1.6±0.5)ng/L,P<0.05】,血清MCP-1水平为(24.8±6.1)pg/mL,显著低于对照组【(185.9±24.3)pg/mL,P<0.05】;观察组术后并发症发生率为6.9%,显著低于对照组(20.8%,P<0.05)。结论采取腹腔镜下规则性肝段或肝叶切除术治疗复杂性IHS患者疗效较好,可能与降低了血清JAK2、STAT3和MCP-1等因子水平,有效缓解了慢性炎症反应有关。

关键词: 肝内胆管结石, 腹腔镜, 规则性肝段或肝叶切除术, Junus激酶蛋白2, 信号转导及转录激活因子3, 单核细胞趋化蛋白1, 疗效

Abstract: Objective To investigate the therapeutic efficacy of laparoscopic regular hepatectomy or lobectomy in treatment of patients with complicated intrahepatic stones (IHS) and serum changes of Junus kinase protein2 (JAK2), signal transduction and transcription activator 3 (STAT3) and monocyte chemoattractant protein 1(MCP-1). Methods 111 patients with complicated IHS were admitted to the Department of Hepatobiliary Surgery in our hospital between January 2017 and January 2020, and were divided into observation (n=58) and control group (n=53) . The patients in the control group received open regular hepatectomy or lobectomy, and those in the observation group received laparoscopic regular hepatectomy or lobectomy. Serum JAK2, STAT3 and MCP-1 were assayed by ELISA. Results The stone clearance rate immediately after operation in the observation group was 91.4%, much higher than 77.4% (P<0.05) and the final stone clearance rate was 98.3%, significantly higher than 88.7% (P<0.05) in the control; the operation time in the observation group was (2.1±0.7) h, much shorter than , the ambulation time was (1.7±0.5) d, significantly shorter than , the eating time was (2.6±0.9) d, significantly shorter than , and the postoperative hospitalization time was (3.8±2.6)d, significantly shorter than 【(9.2±4.4)d, P<0.05】 in the control; three days after operation, serum interleukin -6 level in the observation group was (81.5±9.6) pg/mL, much lower than , serum C- reactive protein level was (59.3±7.5) mg/L, sigfinicantly lower than and serum procalcitonin level was (0.41±0.03)μg/L, significantly lower than 【(0.67±0.05)μg/L, P<0.05】 in the control; serum JAK2 level was (24.8±6.1) pg/mL, much lower than , serum STAT3 level was (152.2±16.1) ng/L, significantly lower than , and serum MCP-1 level was (24.8±6.1) pg/mL, much lower than in the control; the incidence of postoperative complications in the observation group was 6.9%, much lower than 20.8% (P<0.05) in the control.Conclusion The application of laparoscopic regular hepatectomy or lobectomy in treatment of patients with IHS was efficacious, which might be related the reduction of serum inflammatory factors, JAK2, STAT3, MCP-1 levels, and warrants further clinical investigation.

Key words: Intrahepatic bile duct stone, Laparoscopy, Regular hepatectomy or lobectomy, Junus kinase protein 2, Signal transduction and transcription activator 3, Monocyte chemotactic protein 1, Efficacy

杨洁, 杨晨, 陈俊华, 秦汉, 冯磊. 腹腔镜下规则性肝段或肝叶切除术治疗复杂性肝内胆管结石患者疗效再研究[J]. 实用肝脏病杂志, 2021, 24(1): 131-134.

Yang Jie , Yang Chen , Chen Junhua , et al. Efficacy of laparoscopic regular hepatectomy or lobectomy in treatment of patients with complicated intrahepatic stones[J]. Journal of Practical Hepatology, 2021, 24(1): 131-134.

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