腹腔镜联合纤维胆道镜治疗胆囊并胆总管结石的效果及其对患者血清、胆汁炎性因子的影响

目的 观察腹腔镜联合纤维胆道镜治疗胆囊并胆总管结石的效果及其对患者血清、胆汁炎性因子的影响.方法 选取2014年3月至2017年3月汉中市中心医院肝胆外科收治的212例胆囊并胆总管结石患者为研究对象,按随机数表法分为对照组和观察组,每组106例,对照组采用常规开腹手术治疗,观察组采用腹腔镜联合纤维胆道镜治疗,比较两组患者的手术和疼痛情况以及血清、胆汁炎性因子水平.结果 两组患者的结石清除率分别为100.0%(106/106)和98.1%(104/106),差异无统计学意义(P>0.05);观察组患者的手术时间、术中出血量、术后排气时间、住院时间、并发症发生率以及疼痛持续时间为(85.9±15.4)min、(39.1±5.1)mL、(1.7±0.8)d、(6.5±1.9)d、3.8%和(13.7±1.6)h,均少于对照组的(108.9±19.8)min、(96.2±8.7)mL、(3.6±1.7)d、(12.4±3.4)d、15.1%和(18.5±3.8)h,差异均有统计学意义(P<0.05);两组患者的VAS评分以及疼痛发生率比较,差异均无统计学意义(P>0.05);观察组患者术后1 d、术后3 d、术后5 d血清及胆汁中白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)水平均低于同期对照组,差异均有统计学意义(P<0.05),而两组患者术后7 d血清和胆汁中IL-6、hs-CRP和PCT水平比较,差异均无统计学意义(P>0.05).结论 腹腔镜联合纤维胆道镜治疗胆囊并胆总管结石的清石效果较好,其引发的炎性反应较小,有利于患者术后的康复.

Clinical effect of laparoscopy combined with choledochoscopy in the treatment of patients with gallstones and common bile duct stones and its effect on serum and bile inflammatory factors

Objective To observe the clinical effect of laparoscopy combined with choledochoscopy in the treatment of patients with gallstones and common bile duct stones (CBDS) and its effect on serum and bile inflammato-ry factors. Methods From March 2014 to March 2017, 212 cases of patients with gallbladder and CBDS, who admit-ted to Department of Hepatobiliary Surgery of Hanzhong Central Hospital, were selected and divided into the observa-tion group and the control group according to random number table method, with 106 cases in each group. The control group was treated with routine laparotomy, and the observation group was treated with laparoscopy combined with cho-ledochoscopy. The surgical conditions, pain and serum, bile inflammatory factor levels between two groups were com-pared. Results The stone clearance rates in the control group and observation group were respectively 100.0%(106/106) and 98.1% (104/106), and the difference was not significant (P>0.05). Time of operation, intraoperative blood loss, postoperative exhaust time, length of hospital stay, complication rate and pain duration in the observation group were (85.9±15.4) min, (39.1±5.1) mL, (1.7±0.8) d, (6.5±1.9) d, 3.8%(4/104) and (13.7±1.6) h, respectively, which were significantly less than corresponding (108.9±19.8) min, (96.2±8.7) mL, (3.6±1.7) d, (12.4±3.4) d, 15.1%and (18.5±3.8) h in the control group (P<0.05). There was no significant difference in VAS score and pain incidence between the two groups (P>0.05). Interleukin 6 (IL-6), hypersensitive C reactive protein (hs-CRP), and procalcitonin (PCT) levels of se-rum and bile at 1 d, 3 d, 5 d posttreatment in the observation group were significantly less than those in the control group (P<0.05). There was no significant difference in IL-6, hs-CRP and PCT levels of serum and bile at 7 d post-treatment be-tween the two groups (P>0.05). Conclusion Laparoscopic combined with cholecystectomy has satisfactory stone clear-ance effect in the treatment of patients with gallstones and CBDS, which triggers less inflammatory response and is bene-ficial to the rehabilitation of postoperative patients. It is worthy of clinical application.