双镜联合治疗胆囊结石合并肝外胆管结石患者的疗效及安全性分析  

Analysis of the efficacy and safety of laparoscopy combined with duodenoscope for patients with gallbladder stones and extrahepatic bile duct stones

作　　者：宋金珂 田盛霞 胡家艳 李卿明 SONG Jin-ke;TIAN Sheng-xia;HU Jia-yan(Department of Hepatobiliary,First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,China)

机构地区：[1]贵州中医药大学第一附属医院肝胆外科,550001 [2]通用医疗三○○医院肿瘤科,550006

出　　处：《中国现代药物应用》2024年第10期36-40,共5页Chinese Journal of Modern Drug Application

基　　金：贵州省抗癌协会科技计划项目(项目编号:抗协科技[2023]020、抗协科技[2023]019)。

摘　　要：目的对胆囊结石合并肝外胆管结石患者采用双镜联合(腹腔镜联合十二指肠镜)治疗的临床效果和安全性进行分析。方法选择103例胆囊结石合并肝外胆管结石患者,根据手术方案不同分为观察组(61例,行双镜联合下胆囊切除术)和对照组(42例,实施传统开腹手术)。比较两组围术期指标[手术时间、住院时间、出血量、术后视觉模拟评分法(VAS)评分、结石清除率]、血清应激指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、皮质醇(Cor)]、肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转移酶(GGT)]、并发症发生率。结果两组结石清除率均为100.0%,比较无明显差异(P>0.05)。观察组的手术时间(96.3±7.5)min和住院时间(7.5±2.1)d短于对照组的(119.2±10.2)min、(9.4±1.2)d,出血量(25.8±5.4)ml少于对照组的(46.3±6.9)ml,术后VAS评分(2.9±0.8)分低于对照组的(3.4±0.7)分(P<0.05)。术前,两组血清中TNF-α、IL-6、CRP、Cor水平比较无明显差异(P>0.05);术后7 d,两组血清中TNF-α、IL-6、CRP、Cor水平均明显高于术前,但观察组明显低于对照组(P<0.05)。术前,两组的ALT、AST、GGT比较,无明显差异(P>0.05)。术后7 d,观察组的ALT(43.9±4.3)U/L、AST(40.4±4.1)U/L、GGT(154.2±12.9)U/L均低于对照组的(56.9±6.4)、(49.2±5.1)、(193.3±26.5)U/L(P<0.05)。观察组并发症发生率为4.92%,低于对照组的21.43%,差异有统计学意义(P<0.05)。结论胆囊结石合并肝外胆管结石患者治疗中采用双镜联合下胆囊切除术治疗,能够改善围术期各项指标,并使得术后应激反应得到减轻,促进患者的术后恢复,并发症风险也大大降低,因此该方案值得在临床上推广。Objective To analyze the clinical effect and safety of laparoscopy combined with duodenoscope for patients with gallbladder stones and extrahepatic bile duct stones.Methods A total of 103 patients with gallbladder stones and extrahepatic bile duct stones were selected and divided into an observation group(61 cases,laparoscopic combined duodenoscopic cholecystectomy)and a control group(42 cases,conventional open surgery)according to different surgical methods.Both groups were compared in terms of perioperative indicators[operation time,length of hospital stay,blood loss,postoperative visual analogue scale(VAS)score,stone clearance rate],serum stress indicators[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),cortisol(Cor)],liver function indicators[alanine aminotrasferase(ALT),aspartate transaminase(AST),gamma-glutamyltransferase(GGT)],and complication rate.Results The stone clearance rate of both groups was 100.0%,and there was no significant difference(P>0.05).The observation group had operation time of(96.3±7.5)min and length of hospital stay of(7.5±2.1)d,which were shorter than(119.2±10.2)min and(9.4±1.2)d in the control group;the observation group had less blood loss of(25.8±5.4)ml than(46.3±6.9)ml in the control group,and lower VAS score of(2.9±0.8)points than(3.4±0.7)points in the control group(P<0.05).Before surgery,there were no significant differences in serum levels of TNF-α,IL-6,

关 键 词：腹腔镜 十二指肠镜 胆囊切除术 胆囊结石 肝外胆管结石 安全性 疗效 

分 类 号：R657.4[医药卫生—外科学]