中华普外科手术学杂志(电子版)
中華普外科手術學雜誌(電子版)
중화보외과수술학잡지(전자판)
CHINESE JOURNAL OF OPERATIVE PROCEDURES OF GENERAL SURGERY(ELECTRONIC VERSION)
2015年
2期
140-142
,共3页
内窥镜检查%碎石术,激光%肝功能不全
內窺鏡檢查%碎石術,激光%肝功能不全
내규경검사%쇄석술,격광%간공능불전
Endoscopy%Lithotripsy,easer%Hepatic insufficiency
目的:分析胆道镜2μm激光治疗肝内胆管结石并发肝功能不全的原因及预防。方法总结2010年至2014年采用腹腔镜下胆道镜联合2μm激光碎石治疗肝内胆管结石42例,分析严重手术并发症的发生原因。SPSS17.0软件进行统计学分析,患者手术时间、碎石时间、肝功和白细胞指标等,采用均数±标准差( x珋±s)表示, t检验;术前结石大小、单/多发例数、进行χ2检验,P<0.05为差异有统计学意义。结果42例患者中35例患者碎石成功1周内出院,7例患者术后4~5 h内发生肝功能不全,1例抢救无效死亡。回顾性分析所有病例,发现发生肝功不全的患者均ALT高于正常值3倍以上。肝功正常组在手术时间、碎石时间和结石大小方面优于肝功异常组,(45.21±12.3) min与(97.5±19.1) min,(12.3±1.60) min 与(43.1±11.4) min,(1.33±0.27) cm 与(4.49±1.43) cm,差异有统计学意义(χ2=0.096,0.084,0.890, P<0.05)。结论结石大或多发结石导致碎石时间长(>1 h)是肝功能不全的主要原因。
目的:分析膽道鏡2μm激光治療肝內膽管結石併髮肝功能不全的原因及預防。方法總結2010年至2014年採用腹腔鏡下膽道鏡聯閤2μm激光碎石治療肝內膽管結石42例,分析嚴重手術併髮癥的髮生原因。SPSS17.0軟件進行統計學分析,患者手術時間、碎石時間、肝功和白細胞指標等,採用均數±標準差( x珋±s)錶示, t檢驗;術前結石大小、單/多髮例數、進行χ2檢驗,P<0.05為差異有統計學意義。結果42例患者中35例患者碎石成功1週內齣院,7例患者術後4~5 h內髮生肝功能不全,1例搶救無效死亡。迴顧性分析所有病例,髮現髮生肝功不全的患者均ALT高于正常值3倍以上。肝功正常組在手術時間、碎石時間和結石大小方麵優于肝功異常組,(45.21±12.3) min與(97.5±19.1) min,(12.3±1.60) min 與(43.1±11.4) min,(1.33±0.27) cm 與(4.49±1.43) cm,差異有統計學意義(χ2=0.096,0.084,0.890, P<0.05)。結論結石大或多髮結石導緻碎石時間長(>1 h)是肝功能不全的主要原因。
목적:분석담도경2μm격광치료간내담관결석병발간공능불전적원인급예방。방법총결2010년지2014년채용복강경하담도경연합2μm격광쇄석치료간내담관결석42례,분석엄중수술병발증적발생원인。SPSS17.0연건진행통계학분석,환자수술시간、쇄석시간、간공화백세포지표등,채용균수±표준차( x류±s)표시, t검험;술전결석대소、단/다발례수、진행χ2검험,P<0.05위차이유통계학의의。결과42례환자중35례환자쇄석성공1주내출원,7례환자술후4~5 h내발생간공능불전,1례창구무효사망。회고성분석소유병례,발현발생간공불전적환자균ALT고우정상치3배이상。간공정상조재수술시간、쇄석시간화결석대소방면우우간공이상조,(45.21±12.3) min여(97.5±19.1) min,(12.3±1.60) min 여(43.1±11.4) min,(1.33±0.27) cm 여(4.49±1.43) cm,차이유통계학의의(χ2=0.096,0.084,0.890, P<0.05)。결론결석대혹다발결석도치쇄석시간장(>1 h)시간공능불전적주요원인。
Objective To investigate the causes and prevention of hepatolithiasis and hepatic insufficiency by using 2-μm laser treatment under a choledochoscope. Methods 42 patients with hepatolithiasis and hepatic insufficiency underwent 2-μm laser lithotripsy under laparoscope and choledochoscope from 2010 to 2014 in our hospital.The causes of the complications were analyzed using SPSS17.0 software.Operation time, gravel time, indicators of liver function and white blood cells were expressed as mean ±standard deviation, and the results were compared by Student's t test.Preoperative stone size, and single /multiple stones were compared by the chi-square test and P <0.05 was considered statistically significant. Results 35 patients were successfully cured and discharged within a week. Hepatic failure occurred in 7 patients within 4-5 hours after operation, and one of them died.The operation time, and gravel time stone size in patients with normal liver function were superior to those in patients with abnormal liver function (P<0.05).Retrospective analysis of all patients revealed that the ALT level of all 7 patients with hepatic insufficiency was 3 times higher than the normal value.In these patients [ 2 patients with large stones (>2 cm), 5 with multiple stones], lithotripsy time exceeded one hour. Conclusion The main causes of hepatic insufficiency are large volume of stones and longer operation time due to multiple stones (>1 h) .