三镜联合微创手术治疗胆囊结石继发胆总管结石患者的效果  

Outcome of Minimally Invasive Triple-lens Surgery for Patients with Gallbladder Stones Secondary to Common Bile Duct Stones

作　　者：吴大帅 岳珂珂 季予江 季春勇 Wu Dashuai;Yue Keke;Ji Yujiang;Ji Chunyong(Zhengzhou Central Hospital Affiliated to Zhengzhou University 450000 Zhengzhou,Henan)

机构地区：[1]郑州大学附属郑州中心医院肝胆胰微创外科,河南郑州450000

出　　处：《哈尔滨医药》2024年第6期21-23,共3页Harbin Medical Journal

摘　　要：目的探究三镜联合微创手术治疗胆囊结石(GD)继发胆总管结石(CBDS)患者的效果。方法回顾性收集我院90例GD继发CBDS患者病例资料,按手术方案不同分两组。以接受三镜联合微创手术(腹腔镜+胆道镜+十二指肠镜)治疗的45例患者列为A组,以接受双镜联合微创手术(胆道镜+腹腔镜)治疗的45例患者列为B组。对比两组围手术期指标、手术前后视觉模拟评分法(VAS)评分、炎症-应激反应[血清白细胞-1(IL-1)、IL-10、肿瘤坏死因子-α(TNF-α)]水平、结石遗留情况及并发症发生率。结果A组手术用时、肛门排气时间、住院用时相较于B组更短,术中失血量相较于B组更低(P<0.05);A组术后3d,7d VAS评分相较于B组更低(P<0.05);A组结石遗留率2.22%(1/45)相较于B组17.78%(8/45)更低(P<0.05);A组术后1d,3d血清IL-1、IL-10、TNF-α水平相较于B组更低(P<0.05);A组并发症发生率4.44%(2/45)相较于B组22.22%(10/45)更低(P<0.05)。结论相较于双镜联合微创手术治疗GD继发CBDS患者,经三镜联合微创手术治疗可进一步提升结石清除效果,优化围手术期指标,降低术后并发症发生风险,减轻患者疼痛程度,同时对机体造成炎症-应激反应更轻微,更能体现微创手术优势。Objective To investigate the outcome of minimally invasive triple-lens surgery for patients with gallbladder stones(GD)secondary to common bile duct stones(CBDS).Methods The data of 90 patients with GD secondary CBDS were retrospectively collected and divided into 2 groups according to different surgical protocols.45 patients treated with three mirrors combined with minimally invasive surgery(laparoscopy+choledochoscopy+duodenoscope)were classified as group A,and 45 patients treated with two mirrors combined with minimally invasive surgery(choledochoscopy+laparoscopy)were classified as group B.Perioperative indexes,visual analogue scale(VAS)scores before and after surgery,inflammatory stress response[serum leuk-1(IL-1),IL-10,tumor necrosis factor-α(TNF-α)]levels,residual stones and incidence of complications were compared between the two groups.Results The operation time,anal exhaust time and hospital stay in group A were shorter than those in group B,and the intraoperative blood loss was lower than those in group B(P<0.05).The VAS scores of group A at 3d and 7d after surgery were lower than those of group B(P<0.05).The stone retention rate in group A was 2.22%(1/45),which was lower than that in group B,17.78%(8/45)(P<0.05).Serum levels of IL-1,IL-10 and TNF-αin group A were lower than those in group B at 1d and 3d after surgery(P<0.05).The incidence of complications in group A was 4.44%(2/45)compared with 22.22%(10/45)in group B(P<0.05).Conclusion Compared with two-mirror combined minimally invasive surgery for GD patients with secondary CBDS,three-mirror combined minimally invasive surgery can further improve the efficacy of stone removal,optimize perioperative indexes,reduce the risk of postoperative complications,reduce the degree of pain of patients,and cause less inflammatory and stress reactions to the body,which can better reflect the advantages of minimally invasive surgery.

关 键 词：胆囊结石 并发症 胆总管结石 三镜联合 炎症-应激反应 

分 类 号：R575.6[医药卫生—消化系统]