腹腔镜联合胆道镜切开取石术治疗结石性梗阻性胆管炎的效果观察  

Observation on the Effect of Laparoscopic Combined with Choledochoscopy for the Treatment of Obstructive Cholangitis Caused by Stones

作　　者：赵应灿 申东方 范才 Zhao Yingcan;Shen Dongfang;Fan Cai(The 990th Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force,Zhumadian,Henan,463000,China)

机构地区：[1]中国人民解放军联勤保障部队第990医院,河南驻马店463000

出　　处：《黑龙江医学》2025年第2期166-168,共3页Heilongjiang Medical Journal

摘　　要：目的:探究腹腔镜联合胆道镜切开取石术(腹腔镜手术)在结石性梗阻性胆管炎中的应用价值。方法:选取2020年1月—2023年2月中国人民解放军联勤保障部队第990医院收治的行开腹手术治疗的41例结石性梗阻性胆管炎患者临床资料为对照组,另行腹腔镜手术治疗的45例患者资料为腹腔镜组。比较两组患者结石清除率、手术情况、手术前后炎性因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)]水平、肝功能指标[胆碱酯酶(CHE)、谷草转氨酶(GOT)]及并发症情况。结果:腹腔镜组术中出血量较低,手术时间、术后镇痛时间、住院时间较对照组短,差异均有统计学意义(t=35.379、8.216、17.905、3.708,P<0.05);术后1 d、3 d,两组患者血清TNF-α、CRP、IL-6水平均较术前升高,腹腔镜组升高幅度较对照组低,差异均有统计学意义(t=5.310、3.933;t=6.880、9.072;t=3.840、4.000,P<0.05);术后3 d,两组患者CHE水平较术前及术后1 d升高,GOT水平较术前及术后1 d降低,差异均有统计学意义(t=0.799、1.472,P<0.05);两组患者间并发症总发生率比较,差异无统计学意义(χ^(2)=0.843,P>0.05)。结论:腹腔镜联合胆道镜切开取石术治疗结石性梗阻性胆管炎结石清除效果确切,能改善肝功能,且具有较高安全性,尤其在减轻机体炎性损伤,促进术后早期恢复方面优势更加显著。Objective:To explore the application value of laparoscopic combined with choledochoscopy in the treatment of obstructive cholangitis caused by stones.Methods:The clinical data of 41 patients with stone obstructive cholangitis treated by open surgery in the hospital from January 2020 to February 2023 were collected and set as the control group,and the data of 45 patients treated by laparoscopic surgery were set as the laparoscopic group.Stone removal rate,surgical conditions and complications,as well as the levels of inflammatory factors[tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],and liver function indexes[cholinesterase(CHE),ghrelin aminotransferase(GOT)]before and after surgery of two groups were compared.Results:The intraoperative blood loss was lower in the laparoscopic group,and the operative time,postoperative analgesia time and hospital stay were shorter than those in the control group,with statistically significant difference(t=35.379,8.216,17.905,3.708;P<0.05).The serum levels of TNF-α,CRP and IL-6 in 2 groups were higher than those before surgery 1 and 3 days after surgery,and the increases in the laparoscopic group were lower than those in the control group,with statistically significant difference(t=5.310,3.933;t=6.880,9.072;t=3.840,4.000;P<0.05).3 days after surgery,CHE level was higher than that before surgery.1 day after surgery,GOT level was lower than that before surgery and 1 day after surgery.The difference was statistically significant(t=0.799,1.472;P<0.05).There was no significant difference in the total incidence of complications between the two groups(χ^(2)=0.843,P>0.05).Conclusion:Laparoscopic combined with choledochoscopy for lithotomy in the treatment of calculous obstructive cholangitis has a definite effect on stone removal,can improve liver function,and has high safety,especially in reducing inflammatory damage to the body and promoting early postoperative recovery.

关 键 词：胆管炎 结石性 梗阻性 腹腔镜胆囊切除术 胆道镜切开取石术 炎性因子 肝功能 

分 类 号：R657.4[医药卫生—外科学]