三镜联合经腹置入鼻胆管引流术在老年胆囊结石合并胆总管结石中的疗效研究

目的观察腹腔镜联合胆道镜及十二指肠镜经腹置入鼻胆管引流术在老年胆囊结石合并胆总管结石中的疗效并对炎性因子进行分析研究。方法选择陆军军医大学大坪医院2019年1月至12月收治的老年胆囊结石合并胆总管结石患者100例,以随机数字表法分为对照组(50例)与试验组(50例),其中试验组患者采取腹腔镜联合胆道镜及十二指肠镜经腹置入鼻胆管引流术,对照组患者采取腹腔镜下胆总管探查取石T管引流。比较两组患者手术情况(手术时间、术中出血量、手术成功率),术后恢复情况(胃肠功能恢复、引流量、引流管留置时间、住院时间),术后并发症情况,治疗前后炎性指标水平。结果两组患者术中出血量、手术成功率相比,差异无统计学意义。与对照组相比,试验组患者手术时间明显延长(P<0.001),术后胃肠功能恢复时间、引流管留置时间及住院时间明显缩短,术后1、2 d引流量更少(P<0.001)。试验组患者术后并发症发生率明显低于对照组(4.00%vs 20.00%,χ^2=6.061,P=0.014)。治疗后两组患者的炎性指标水平较治疗前明显降低,且试验组明显低于对照组(P<0.01)。结论对于老年胆囊结石合并胆总管结石患者,以腹腔镜联合胆道镜及十二指肠镜经腹置入鼻胆管引流术治疗,可明显获得较高的手术成功率,缩短引流管留置时间,减少患者术后并发症和炎性反应,有效缩短患者住院时间,效果理想。

Effect of three endoscopy combined with transabdominal nasobiliary drainage in elderly patients with cholecystolithiasis and choledocholithiasis

Objective To observe the effect of the laparoscopy combined with choledochoscope and duodenoscopy in the treatment of elderly patients with cholecystolithiasis and choledocholithiasis,and to analyze the influence on inflammatory factors.Methods From January to December 2019,100 elderly patients with cholecystolithiasis and choledocholithiasis were selected and randomly divided into the control group(50 cases)and the trial group(50 cases)from Daping Hospital Affiliated to Army Medicine University.The trial group was treated by laparoscopy combined with choledochoscopy and duodenoscopy,and the control group was treated with laparoscopic common bile duct exploration T-tube drainage.The operation conditions(operation time,intraoperative blood loss,operation success rate),postoperative recovery(gastrointestinal function recovery,drainage volume,drainage tube indwelling time,hospitalization time),postoperative complications,and inflammatory index levels before and after treatment were compared between the two groups.Results There were no significant differences in blood loss and success rate between the two groups.Compared with the control group,the operation time of the trial group was significantly prolonged(P<0.001),the recovery time of gastrointestinal function,the indwelling time of drainage tube and the hospitalization time were significantly shortened,and the drainage volume was less on the 1st and 2nd day after operation(P<0.001).The incidence of postoperative complications in the trial group was significantly lower than that in the control group(4.00%vs 20.00%,χ^2=6.061,P=0.014).After treatment,the inflammatory index levels of the two groups were significantly lower than those before treatment,and the trial group was significantly lower than the control group(P<0.01).Conclusion In the treatment of elderly patients with cholecystolithiasis and choledocholithiasis,transabdominal placement of nasobiliary drainage through laparoscopy combined with choledochoscope and duodenoscopy can obviously obtain higher success rate of operation,shorten the indwelling time of drainage tube,reduce the occurrence of postoperative complications,reduce postoperative inflammatory reaction,effectively shorten the hospitalization time of patients,and the effect is ideal.