腹腔镜经胆囊管胆道探查术治疗肝外胆管结石的疗效分析

目的探讨腹腔镜经胆囊管胆道探查术治疗肝外胆管结石的疗效。方法选取2014年2月至2017年1月在阿克苏地区第一人民医院治疗的肝外胆管结石患者140例,按治疗方式分为3组:A组接受腹腔镜胆囊切除和经胆囊管胆道探查(n=52),B组接受腹腔镜胆囊切除+胆总管切开探查+胆管一期缝合(n=46),C组接受腹腔镜胆囊切除+胆总管切开探查+T管引流(n=42),观察三组手术时间、术中出血量、腹腔引流时间、住院时间、住院费用、恢复正常生活时间及并发症发生情况,同时采用激素免疫法测定三组患者手术前后肾上腺素、皮质醇水平变化,采用酶联免疫法测定三组患者手术前后白细胞介素-6(IL-6)和C反应蛋白(CRP)水平变化。结果 C组手术时间为(120.04±12.26)min,明显长于A组和B组(P0.05);B组和C组术中出血量为(63.28±23.14)m L(62.42±21.01)m L、,明显多于A组(P0.05);A组腹腔引流时间为(3.41±0.33)d,明显短于B组和C组(P0.05);B组腹腔引流时间为(4.12±0.54)d,明显短于C组(P0.05);C组住院时间、住院费用和恢复正常生活时间分别为(7.60±1.26)d、(21 104.11±483.90)元和(38.27±1.98)d,明显多于A组和B组(P0.05);C组术后肾上腺素、皮质醇、IL-6和CRP分别为(220.32±42.06)ng/m L、(562.17±142.51)nmol/L、(109.62±18.87)μg/L和(4.82±2.98)mg/L,明显高于A组(P0.05);三组术后并发症发生率比较差异无统计学意义(P0.05)。结论腹腔镜经胆囊管胆道探查术治疗胆管结石有较好的效果,值得临床推广使用。

Curative effect analysis of laparoscopic bile duct exploration through cystic duct for the treat- ment of extrahepatic bile duct calculus

Objective To investigate the curative effect of laparoscopic bile duct exploration through cystic duct for the treatment of extrahepatic bile duct calculus. Methods A total of 140 patients with extrahepatic bile duct calculus treated in the First People's Hospital of Aksu from Feb. 2014 to Jan. 2017, were selected and di-vided into group A (n=52), group B (n=46) and group C (n=42). Group A received laparoscopic cholecystectomy and bile duct exploration through cystic duct, group B received laparoscopic cholecystectomy, common bile duct exploration and bile duct primary suture, and group C received laparoscopic cholecystectomy, common bile duct exploration and T tube drainage. The operation duration, intraoperative blood loss, abdominal drainage time, hospitalization duration, hospitalization expenses, the time return to normal life and complications were observed among the three groups. At the same time, the changes of adrenaline and cortisol levels of the three groups be-fore and after the operation were measured by hormone immunoassay, and the changes of interleukin-6 (IL-6) and C reactive protein (CRP) levels of the three groups before and after operation were measured by enzyme-linked immunoassay. Results The operation duration of group C was (120.04±12.26)min, which was obviously longer than those of group A and group B (P<0.05); the intraoperative blood loss of group B and group C were (63.28±23.14)mL and (62.42±21.01)mL, which were significantly more than that of group A (P<0.05); The abdominal drainage time of group A was (3.41±0.33) d, which was significantly shorter than those of group B and group C (P<0.05). The abdominal drainage time of group B was (4.12±0.54) d, which was significantly shorter than that of group C (P<0.05). The hospitalization time, hospitalization expenses and the time return to normal life of group C were (7.60±1.26) d, (21104.11±483.90) Yuan and (38.27±1.98) d, which were significantly more than those of group A and group B (P<0.05). After operation, the levels adrenaline, cortisol, IL-6 and CRP were (220.32±42.06) ng/mL, (562.17±142.51) nmol/L, (109.62±18.87) μg/L and (4.82±2.98) mg/L, which were sig-nificantly higher than those of group A (P<0.05). There was no significant difference in the incidence of postop-erative complications among the three groups (P>0.05). Conclusion Laparoscopic bile duct exploration through cystic duct for the treatment of calculus of bile duct has a good effect, and which is worthy of clinical use.