摘要
目的探讨2种腹腔镜手术在胆囊结石合并胆总管结石患者中的疗效及对炎性因子的影响。方法收集2021年5月至2024年5月在我院普外科接受腹腔镜手术治疗的胆囊结石合并胆总管结石患者100例的临床资料,按照手术方法将其分为2组,各50例。其中对照组实施内镜逆行胰胆管造影术联合胆囊切除法,观察组实施腹腔镜胆总管探查联合胆囊切除术。采用t检验比较2组患者的手术指标(住院时间、手术时间、术中出血量、术后首次排便时间、术后首次排气时间)、胃肠道生活质量指数(GIQLI)、炎性因子[白细胞介素-8(IL-8)、视黄醇结合蛋白(RBP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)];采用χ^(2)检验比较2组并发症发生率、结石清除率及复发率。结果对照组术后首次排便、排气时间及手术时间均较观察组长[(3.73±0.65)d与(2.14±0.45)d t=14.221,P<0.001;(2.26±0.67)d与(1.46±0.52)d(t=6.670,P<0.001)、(144±27)min与(113±24)min,t=5.989,P<0.001];术后对照组上消化道功能、体力、心理及情感、肠功能评分均显著高于对照组(P<0.05);术后2组炎性因子与术前比较均有变化,且对照组IL-8、TNF-α及IL-8水平均低于对照组,RBP水平高于对照组(P<0.001);对照组手术成功率低于对照组[80%(40/50)与96%(48/50),χ^(2)=6.061,P=0.014],复发率高于对照组[16%(8/50)与2%(1/50),χ^(2)=5.983,P=0.014];2组住院时间、并发症发生率、结石清除率、术中出血量比较,差异均无统计学意义(P>0.05)。结论相较于内镜逆行胰胆管造影术联合胆囊切除法,腹腔镜胆总管探查联合胆囊切除术治疗胆囊结石合并胆总管结石能缩短手术时间,促进术后胃肠功能恢复,显著改善患者生活质量,减轻全身炎性反应,提高手术成功率并降低复发率。
Objective To investigate the efficacy of two laparoscopic procedures and their impact on inflammatory factors in patients with gallstones combined with common bile duct stones.Methods Clinical data of 100 patients with gallbladder stones and common bile duct stones who received laparoscopic surgery in the general surgery department of Gutian County Hospital of Ningde City from May 2021 to May 2024 were collected and retrospectively reviewed.And they were divided into two groups according to the surgical methods,with 50 cases in each group.Among them,the control group underwent endoscopic retrograde cholangiopancreatography combined with cholecystectomy,and the observation group underwent laparoscopic common bile duct exploration combined with cholecystectomy.The t-test was used to compare the surgical indicators(hospitalization time,operative time,intraoperative blood loss,first postoperative defecation time,first postoperative gas passage time),gastrointestinal quality of life index(GIQLI),and inflammatory factors[interleukin-8(IL-8),retinol-binding protein(RBP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]between the two groups of patients,Theχ^(2)test was used to compare the incidence of complications,stone clearance rate,and recurrence rate between the two groups.Results The control group had shorter times for the first bowel movement and flatus passage after surgery,as well as longer operative times compared to the observation group[(3.73±0.65)d vs.(2.14±0.45)d,(t=14.221,P<0.001)(2.26±0.67)d vs.(1.46±0.52)d(t=6.670,P<0.001),(144±27)min vs.(113±24)min,t=5.989,P<0.001].Postoperative evaluations showed that the observation group had significantly higher scores in upper gastrointestinal function,physical function,psychological and emotional status,and intestinal function compared to the control group(P<0.05).Postoperative inflammatory factors in both groups changed compared to preoperative levels,with the observation group showing lower levels of IL-6,TNF-α,and IL-8,and higher RBP levels compared to the control group(P<0.05).The control group had a lower surgical success rate[80%(40/50)vs.96%(48/50),χ^(2)=6.061,P=0.014]and a higher recurrence rate[16%(8/50)vs.2%(1/50),χ^(2)=5.983,P=0.014].There were no statistically significant differences in hospital stay,complication rate,stone clearance rate,or intraoperative blood loss between the two groups(P>0.05).Conclusion Compared with endoscopic retrograde cholangiopancreatog-raphy combined with cholecystectomy,laparoscopic common bile duct exploration combined with cholecystectomy for gallbladder stones combined with common bile duct stones can shorten the operative time,promote the postoperative recovery of gastrointestinal function,significantly improve the quality of life,reduce systemic inflammatory response,improve the success rate of surgery and lower the recurrence rate.
作者
王洋
Wang Yang(Department of Cteneral Surgery I,Gutian County Hospital of Ningde City,Ningde 352200,China)
出处
《实用医技杂志》
2025年第10期784-788,共5页
Journal of Practical Medical Techniques
关键词
胆囊结石病
腹腔镜检查
胆总管结石病
胃肠疾病
炎性因子
Gholecystolithiasis
Laparoscopy
Choledocholithiasis
Gastrointestinal diseases
Inflammatory factors
