双镜微创保胆术与胆囊切除术的临床效果比较及对血浆VIP、CCK水平的影响  

Comparison of Clinical Effects of Laparoscopic and Choledochoscopic Gallbladder-Preserving Cholelithotomy and Cholecystectomy and Influence on Levels of Plasma VIP and CCK

作　　者：徐红伟 王迎[1] 王大军[1] 苗志钊 王建国[1] XU Hong-wei;WANG Ying;WANG Da-jun;MIAO Zhi-zhao;WANG Jian-guo(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院肝胆外科,河南卫辉453100

出　　处：《罕少疾病杂志》2021年第6期54-57,共4页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨双镜微创保胆术与胆囊切除术治疗胆囊结石的临床效果。方法回顾性分析2016年1月至2018年12月间收治的162例胆囊结石患者临床资料,根据手术方式分为保胆术组(n=72)和切除术组(n=90)。保胆术组行腹腔镜与胆道镜联合保胆取石术,切除术组行腹腔镜胆囊切除术(LC)。比较两组围术期情况(手术时间、术中出血、术后肛门排气时间、住院时间),术前、术后1d、术后3d评估患者创伤应激反应[C反应蛋白(CRP)、内皮素(ET)、肿瘤坏死因子α(TNF-α)],术前、术后3个月后评估患者胃肠激素[血浆血管活性肠肽(VIP)、胆囊收缩素(CCK)]及肝外胆管直径,记录两组术后并发症发生率和生活质量[消化病生存质量指数(GLQI)]。结果保胆术组手术时间长于切除术组、术中出血少于切除术组(P<0.05);术后1d、术后3d,保胆术组C反应蛋白(CRP)、内皮素(ET)、肿瘤坏死因子α(TNF-α)均低于切除术组(P<0.05);术后3月,两组血浆血管活性肠肽(VIP)均低于术前(P<0.05),两组胆囊收缩素(CCK)均高于术前(P<0.05),保胆术组变化幅度大于切除术组(P<0.05),两组肝外胆管直径均大于术前(P<0.05),保胆术组增幅小于切除术组(P<0.05);保胆术组腹痛、腹泻、脂肪泻发生率均低于切除术组(P<0.05);术后3个月,两组消化病生存质量指数(GLQI)得分均高于术前(P<0.05),保胆术组增幅大于切除术组(P<0.05)。结论双镜微创保胆术治疗胆囊治疗较LC安全且并发症发生率低,更有利于保护胆囊生理机能。Objective To investigate the clinical effects of laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy and cholecystectomy in the treatment of gallstones.Methods The clinical data of 162 patients with gallstones admitted between January 2016 and December2018 were retrospectively analyzed.According to the surgical procedures,the patients were divided into gallbladder-preserving surgery group(n=72)and resection group(n=90).Gallbladder-preserving surgery group was given laparoscopic and choledochoscopic gallbladderpreserving cholelithotomy,and resection group was treated with laparoscopic cholecystectomy(LC).The perioperative conditions(surgery time,intraoperative blood loss,postoperative anal exhaust time,hospital stay)were compared between the two groups.The changes of traumatic stress response[C-reactive protein(CRP),endothelin(ET),tumor necrosis factorα(TNF-α)]were evaluated before surgery and at 1 d and 3 d after surgery.The gastrointestinal hormones[plasma vasoactive intestinal peptide(VIP),cholecystokinin(CCK)]and diameter of extrahepatic bile duct were evaluated before surgery and at 3 months after surgery.The incidence rates of postoperative complications and quality of life[Gastrointestinal Life Quality Index(GLQI)]were recorded in the two groups.Results The surgery time in gallbladder-preservingsurgery group was longer than that in resection group,and the intraoperative blood loss was less than that in resection group(P<0.05).At 1 d and 3 d after surgery,the levels of C-reactive protein(CRP),endothelin(ET)and tumor necrosis factorα(TNF-α)ingallbladder-preservingsurgery groupwere lower than those in resection group(P<0.05).At 3 months after surgery,the plasma vasoactive intestinal peptide(VIP)values in the two groups were lower than those before surgery(P<0.05)while the cholecystokinin(CCK)values in the two groups were higher than those before surgery(P<0.05),and the changes in gallbladder-preserving surgery group were greater than those in resection group(P<0.05).The diameters of ext

关 键 词：胆囊结石 双镜微创保胆术 腹腔镜胆囊切除术 胃肠激素 

分 类 号：R657.4[医药卫生—外科学]