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

Abstract

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

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.

References

[1] Ogura T, Okuda A, Miyano A, et al. Intrahepatic bile duct stone removal through endoscopic ultrasound-guided hepaticogastrostomy using novel basket catheter under digital cholangioscopy guidance. Endoscopy, 2018, 50(10): E301-E303.
[2] Li EL, Yuan RF, Liao WJ, et al. Intrahepatic bile duct exploration lithotomy is a useful adjunctive hepatectomy method for bilateral primary hepatolithiasis: an eight-year experience at a single centre. BMC Surg, 2019, 19(1): 16.
[3] Zhang Z, Liu Z, Liu L, et al. Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones. Front Med, 2017, 11(4): 576-589.
[4] Yang J, Zhang F, Du X, et al. Laparoscopic hepatectomy combined with endoscopic papillary balloon dilation for complex bile duct stones. ANZ J Surg, 2018, 88(6): E522-E525.
[5] 中华医学会外科学分会胆道外科学组. 肝胆管结石病诊断治疗指南. 中华消化外科杂志, 2007, 6(2): 156-161.
[6] Fortune BE, Garcia-Tsao G, Ciarleglio M, et al. Child-Turcotte-Pugh class is best at stratifyingrisk in variceal hemorrhage: analysis of a us multicenter prospective study. J Clin Gastroenterol, 2017, 51(5): 446-453.
[7] Chen WX, Li GX, Hu ZN, et al. Significant response to anti-pd-1 based immunotherapy plus lenvatinib for recurrent intrahepatic cholangiocarcinoma with bone metastasis: a case report and literature review. Medicine (Baltimore), 2019, 98(45): e17832.
[8] Parra-Membrives P, Martínez-Baena D, Lorente-Herce JM, et al. Choledocholithiasis recurrence following laparoscopic common bile duct exploration. Cir Esp, 2019, 97(6): 336-342.
[9] Cremer A, Arvanitakis M. Diagnosis and management of bile stone disease and its complications. Minerva Gastroenterol Dietol, 2016, 62(1): 103-129.
[10] Roh YJ, Kim JW, Jeon TJ, et al. Common bile duct stone development due to a hem-o-lok clip migration: a rare complication of laparoscopic cholecystectomy. BMJ Case Rep, 2019, 12(7): e230178.
[11] 李依川, 彭彬, 辛大平. 精准肝切除与非规则性肝切除治疗肝内胆管结石的疗效对比.中华普外科手术学杂志(电子版), 2018, 12(1): 71-73.
[12] 蔡辉华, 杨勇, 杨雨, 等. 腹腔镜左肝规则性切除联合胆道镜在肝内外胆管结石中的应用. 中华普通外科杂志, 2019, 1(10): 899-901.
[13] Shin YC, Jang JY, Kang MJ, et al. Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg Endosc, 2016, 30(1): 259-65.
[14] 王文斌, 闫长青, 吕海涛, 等.腹腔镜解剖性肝切除术临床分析. 中华肝胆外科杂志, 2016, 22(1): 9-12.
[15] Daldoul S, Mabrouk A, Messoudi I, et al. Multiple bile duct stones: comparison of two surgical techniques done at laparotomy. Tunis Med, 2016, 94(11): 643.
[16] Shih DM, Yu JM, Vergnes L, et al. Pon3 knockout mice are susceptible to obesity, gallstone formation, and atherosclerosis. FASEB J, 2015, 29(4): 1185-1197.
[17] 贺德龙, 周为, 薛长梅, 等. 完全腹腔镜下规则性左肝切除术治疗左肝胆管结石的临床研究. 中华普外科手术学杂志(电子版), 2018, 12(5): 448-450.
[18] Li H, Peng B. Laparoscopic anatomical left hepatectomy for intrahepatic bile duct papillary mucinous cystadenoma with intraoperative vascular repair: a case report. Medicine (Baltimore),. 2016, 95(6): e2802.
[19] Chuang SH, Hung MC, Huang SW, et al . Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: choledochotomy, transcystic, and transfistulous approaches. Surg Endosc, 2018, 32(1): 485-497.
[20] 钱国武, 崔广莹, 宋展, 等. 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. 实用肝脏病杂志, 2020, 23(1): 122-125.

Efficacy of laparoscopic regular hepatectomy or lobectomy in treatment of patients with complicated intrahepatic stones

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