腹腔镜结合胆道镜手术对胆囊结石合并胆总管结石患者炎症因子及并发症的影响  

Effects of laparoscopy combined with choledochoscopy on inflammatory factors and complications in patients with cholecystolithiasis and choledocholithiasis

作　　者：孙智国 王登强 李波 龚根强[3] SUN Zhiguo;WANG Dengqiang;LI Bo;GONG Genqiang(General Surgery Department,Fufeng People's Hospital,Baoji 722200;General Surgery Department,Zhen'an Hospital,Shangluo 711500;Emergency Surgery Department,Baoji Central Hospital,Baoji 721008,China)

机构地区：[1]扶风县人民医院普外科,陕西宝鸡722200 [2]镇安县医院普外科,陕西商洛711500 [3]宝鸡市中心医院急诊外科,陕西宝鸡721008

出　　处：《临床医学研究与实践》2024年第2期84-87,92,共5页Clinical Research and Practice

摘　　要：目的探讨腹腔镜结合胆道镜手术对胆囊结石合并胆总管结石患者炎症因子及并发症的影响。方法选取2018年2月至2022年6月收治的80例胆囊结石合并胆总管结石患者作为研究对象,将其随机分为腹腔镜组和双镜组,每组40例。腹腔镜组采用腹腔镜手术治疗,双镜组采用腹腔镜结合胆道镜手术治疗。比较两组的治疗效果。结果两组的手术时长、术中出血量比较,差异无统计学意义(P>0.05);双镜组的卧床时长、肠鸣音恢复时间、引流管留置时长、住院时长短于腹腔镜组(P<0.05)。双镜组的结石清除率高于腹腔镜组,并发症总发生率低于腹腔镜组(P<0.05)。术后,双镜组的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-17(IL-17)、去甲肾上腺素(NE)、皮质醇(Cor)及C肽(CP)水平均低于腹腔镜组,差异具有统计学意义(P<0.05)。术后,双镜组的血管紧张素1-7(Ang1-7)、血管紧张素Ⅰ(AngⅠ)、血管紧张素Ⅱ(AngⅡ)、总胆红素(TBIL)、间接胆红素(IBIL)及直接胆红素(DBIL)水平均低于腹腔镜组(P<0.05)。结论腹腔镜结合胆道镜手术可缩短胆囊结石合并胆总管结石患者的康复周期,降低并发症发生风险,提高结石清除率,减轻术后炎症、应激反应,改善肝胆功能,值得在临床实践中推广及应用。Objective To explore the effects of laparoscopy combined with choledochoscopy on inflammatory factors and complications in patients with cholecystolithiasis and choledocholithiasis.Methods A total of 80 patients with cholecystolithiasis and choledocholithiasis admitted from February 2018 to June 2022 were selected as the study objects.The patients were randomly divided into laparoscopy group and double-mirror group,with 40 cases in each group.The laparoscopy group was treated with laparoscopy,and the double-mirror group was treated with laparoscopy combined with choledochoscopy.The therapeutic effects of the two groups were compared.Results There were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05);the bed rest time,bowel sound recovery time,drainage tube indwelling time and hospitalization time of the double-mirror group were shorter than those of the laparoscopy group(P<0.05).The stone clearance rate of the double-mirror group was higher than that of the laparoscopy group,the total incidence of complications was lower than that of the laparoscopy group(P<0.05).After surgery,the levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-17(IL-17),norepinephrine(NE),cortisol(Cor)and C-peptide(CP)in the double-mirror group were lower than those in the laparoscopy group,and the differences were statistically significant(P<0.05).After surgery,the levels of angiotensin 1-7(Ang1-7),angiotensinⅠ(AngⅠ),angiotensinⅡ(AngⅡ),total bilirubin(TBIL),indirect bilirubin(IBIL)and direct bilirubin(DBIL)in the double-mirror group were lower than those in the laparoscopy group(P<0.05).Conclusion Laparoscopy combined with choledochoscopy can shorten the rehabilitation cycle of patients with cholecystolithiasis and choledocholithiasis,reduce the risk of complications,improve the stone clearance rate,reduce postoperative inflammation and stress response,and improve hepatobiliary function.It is worthy of promotion and application in clinical practice.

关 键 词：胆囊结石 胆总管结石 腹腔镜 胆道镜 

分 类 号：R657.4[医药卫生—外科学]