关键词: 肝内胆管结石, 胆道镜取石, 左半肝切除术, 治疗

Abstract: Objective This study was to investigate choledochoscope stone removal (CSR) during laparoscopic left hepatectomy (LLH) in dealing with patients with sophisticated intrahepatic bile duct stones (sIHBDS). Methods 100 patients with sIHBDS were encountered in our hospital between April 2022 and December 2023, and were randomly assigned to underwent LLH in control (n=50) or underwent CSR during LLH in observation (n=50). Serum C-reactive protein (CRP level was detected by ELISA, serum cortisol (COR) and epinephrine (EP) levels were measured by using chemiluminescence immunoassay, and peripheral blood lymphocyte subsets and natural killer cells were determined by FCA. Results Intrahepatic stone clearance rate in the observation group was 92.0%, much higher than 76.0%(P＜0.05)in the control as confirmed by US two months after surgery; by end of seven days after operation, white blood cell count, percentage of neutrophils andserum CRP level in the observation group were (6.6±1.1)×10⁹/L, (73.1±6.3)% and (13.2±2.2)mg/L, all much lower than [(7.7±1.1)×10⁹/L, (77.9±6.9)% and (18.0±2.1)mg/L, respectively, P<0.05] in the control; there were no significantly differences as respect to serum COR and EP levels between the two groups (P＞0.05); serum bilirubin, ALT and AST levels were (20.4±6.0)μmol/L, (73.9±20.2)U/L and (50.2±9.8)U/L, all much lower than [(27.0±8.1)μmol/L, (94.0±23.4)U/L and (51.3±10.9)U/L, respectively, P<0.05] in the control; percentages of peripheral blood CD3⁺, CD4⁺ and NK cells were (68.4±6.5)%, (41.1±5.0)% and (18.7±2.2)%, all significantly higher than [(62.1±6.0)%, (37.2±4.2)% and (15.5±2.1)%, P<0.05], while percentage of CD8⁺ cells was(20.3±3.2)%, significantly lower than [(24.0±3.1)%, P<0.05] in the control group. Conclusion Choledochoscopy-assisted LLH in patients with sIHBDS could improve stone removal, promote liver function test recovery and enhances immune functions, and the long-term efficacy needs further clinical observation.

Key words: Intrahepatic bile duct stones, Choledochoscope stone removal, Laparoscopic left hepatectomy, Therapy