腹腔镜联合胆道镜及传统开腹手术对胆石症并发胰腺炎患者应激免疫及炎症的影响  

Effects of laparoscopy combined with choledochoscopy and traditional laparotomy on stress,immunity,and inflammation in cholelithiasis patients complicated with pancreatitis

作　　者：彭飞 张华甫 罗晓 李建朝 PENG Fei;ZHANG Hua-fu;LUO Xiao;LI Jian-chao(Department of Emergency,Zhumadian Central Hospital,Zhumadian,Henan 463000,China;Outpatient Department of Zhumadian Central Hospital,Zhumadian,Henan 463000,China;Department of Extracorporeal Circulation,Fuwai Huazhong Cardiovascular Hospital,Zhengzhou 450000,China)

机构地区：[1]驻马店市中心医院急诊科,河南驻马店463000 [2]驻马店市中心医院门诊部,河南驻马店463000 [3]阜外华中心血管病医院体外循环科,郑州450000

出　　处：《医药论坛杂志》2025年第4期360-364,371,共6页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220112)。

摘　　要：目的比较腹腔镜联合胆道镜及传统开腹手术对胆石症并发胰腺炎患者术后恢复、氧化应激指标、免疫及炎症指标、生活质量及并发症的影响。方法纳入2022年1月—2023年12月驻马店市中心医院收治的胆石症并发胰腺炎患者80例为调查对象,随机分为对照组(n=40)及观察组(n=40)。对照组接受传统开腹手术,观察组接受腹腔镜联合胆道镜治疗,比较两组患者术后恢复、氧化应激指标、免疫及炎症指标、生活质量及并发症发生率。结果与对照组相比,观察组术中出血量显著减少(P<0.001),肠鸣音恢复时间、肛门排气时间、排便时间及术后住院时间均显著缩短(P<0.001)。术后观察组患者GSH-Px及SOD丰度显著高于对照组(P<0.001),且MDA丰度显著低于对照组(P<0.001)。与术前相比,两组患者术后血清IgG丰度均显著下降(P<0.05),血清PCT丰度均显著上升(P<0.001);术后与对照组相比,观察组患者血清IgG丰度显著上升(P<0.001),PCT丰度显著下降(P<0.05)。与术前相比,两组患者术后生活质量量表各维度评分均上升,且术后观察组生活质量量表各维度评分均显著高于对照组(P<0.001)。与对照组(20.00%)相比,观察组并发症发生率(2.50%)显著下降(χ^(2)=6.135,P=0.013)。结论腹腔镜联合胆道镜能显著促进患者术后恢复,减轻机体应激反应,提高生活质量并减少并发症的发生风险。Objective To compare the effects of laparoscopy combined with choledochoscopy and traditional laparotomy on postoperative recovery,oxidative stress indexes,immune and inflammatory indexes,quality of life,and complications in cholelithiasis patients complicated with pancreatitis.Methods A total of 80 cases with cholelithiasis complicated with pancreatitis admitted to Zhumadian Central Hospital from January 2022 to December 2023 were included as investigation objects,and randomly assigned to control and observation groups(n=40).The control group received traditional laparoto⁃my,and the observation group received laparoscopy combined with choledochoscopy.The postoperative recovery,oxidative stress indexes,immune and inflammatory indexes,quality of life,and incidence of complications were compared between the two groups.Results Compared with the control group,the amount of blood loss during operation in the observation group was prominently declined(P<0.001),and the recovery time of bowel sound,anal exhaust time,defecation time,and postoperative hospitalization time were prominently shortened(P<0.001).The abundance of GSH-Px and SOD in observation group was prominently enhanced compared with those in control group(P<0.001),and the abundance of MDA was prominently lower than those in control group(P<0.001).Compared with pre-operation,serum IgG abundance was prominently declined(P<0.05)and serum PCT abundance was prominently enhanced(P<0.001)in both groups.Com⁃pared with the control group,the serum IgG abundance in the observation group was prominently enhanced(P<0.001),and the serum PCT abundance was prominently declined(P<0.05).Compared with the preoperative data,the scores of all dimensions of the QOL in both groups enhanced after surgery,and the scores of the QOL in the observation group after surgery were prominently enhanced compared with those in the control group(P<0.001).Compared with the control group(20.00%),the complication rate in the observation group(2.50%)was prominently declined(χ^(2)=6.135,P=0.01

关 键 词：胆石症 胰腺炎 腹腔镜 胆道镜 术后恢复 应激反应 

分 类 号：R657.4[医药卫生—外科学] R576[医药卫生—临床医学]