腹腔镜联合胆道镜保胆取石术治疗胆囊结石效果观察  

Efficacy of laparoscopy combined with choledochoscopy lithotripsy for patients with cholecystolithiasis

作　　者：吴海俊 周君[1] 李辉华 周海军[1] WU Haijun;ZHOU Jun;LI Huihua;ZHOU Haijun(Department of General Surgery,Jiaxing Traditional Chinese Medicine Hospital,Jiaxing 314001,China)

机构地区：[1]嘉兴市中医医院普外科,314001

出　　处：《浙江医学》2022年第24期2656-2658,2664,共4页Zhejiang Medical Journal

摘　　要：目的 探讨腹腔镜联合胆道镜取石术(LRCL)治疗胆囊结石的效果及对患者应激反应的影响。方法 选择2016年1月至2020年12月嘉兴市中医医院收治的胆囊结石患者120例,其中采用LRCL治疗的观察组和腹腔镜胆囊切除术(LC)治疗的对照组各60例。比较两组患者手术耗时、术中失血量和术后住院时间、胃肠功能恢复时间(包括肠鸣音恢复时间、排便时间和排气时间)和并发症发生情况,以及术前和术后第3天应激反应指标[包括血清皮质醇(Cor)和去甲肾上腺素(NE)]变化的差异。结果 观察组患者手术耗时长于对照组,术后住院时间短于对照组,术后肠鸣音恢复时间、排便时间和肛门排气时间均短于对照组(均P<0.05)。观察组术后并发症发生率低于对照组(P<0.05)。两组患者术后第3天血清Cor和NE水平均较术前升高(均P<0.05);观察组患者术后第3天血清Cor和NE水平均低于对照组(均P<0.05)。结论 胆囊结石患者采用LRCL治疗效果更好,术后并发症发生率低,胃肠功能恢复快,对手术应激反应较小。Objective To evaluate the efficacy of laparoscopy combined with choledochoscopic lithotomy(LRCL) in treatment of patients with cholecystolithiasis. Methods One hundred and twenty patients with cholecystolithiasis admitted in Jiaxing Traditional Chinese Medicine Hospital from January 2016 to December 2020 were divided into two groups: 60 patients were treated with laparoscopy combined with choledochoscopy(study group), and 60 patients underwent laparoscopic cholecystectomy(control group). The curative effects, perioperative indexes(operation time,intraoperative blood loss and postoperative hospital stay), postoperative gastrointestinal function recovery(recovery time of bowel sounds, first exhaust time and anal exhaust time) and postoperative complications were compared between two groups. The stress response indexes before and 3 days after operation in two groups were also measured. Results The total effective rate of study group was higher than that of control group(P < 0.05). The operation time was longer,the postoperative hospital stay was shorter in study group than those in the control group(P < 0.05). There was no significant difference in intraoperative blood loss between two groups(P > 0.05). The recovery time of bowel sounds, first exhaust time and anal exhaust time were short, the postoperative complications were less in the study group than those in the control group(all P < 0.05). Compared with those before operation the serum cortisol(Cor) and noradrenaline(NE)were higher 3d after operation in both groups(P < 0.05);while the levels in study group were lower than those in control group(P < 0.05). Conclusion Laparoscopy combined with choledochoscopic lithotomy is effective in treatment of patients with gallstone, which can reduce postoperative complications, accelerate restore gastrointestinal function, and has less effect on stress response.

关 键 词：腹腔镜 胆道镜 取石术 胆囊结石 效果 应激反应 

分 类 号：R657.42[医药卫生—外科学]