双镜联合经胆囊管钬激光碎石术对胆囊结石合并胆总管结石患者术后恢复情况的影响

Effect of Dual Mirror Combined with Transcystic Holmium Laser Lithotripsy on Postoperative Recovery in Patients with Gallstone and Choledocholithiasis

目的探讨双镜联合经胆囊管钬激光碎石术在胆囊结石合并胆总管结石患者中的应用效果。方法选取枣庄市台儿庄区人民医院2020年8月—2022年8月收治的84例胆囊结石合并胆总管结石患者为研究对象,按随机数字表法分为两组,每组42例。对照组行开腹手术,观察组行双镜联合经胆囊管钬激光碎石术。比较两组患者的手术情况、疼痛评分、肝胆功能指标、生活质量及并发症发生情况。结果观察组的术后排气时间、下床活动时间及住院时间分别为(32.54±3.58)h、(1.65±0.24)d、(8.96±1.12)d,均短于对照组的(58.52±5.12)h、(3.42±0.45)d、(12.41±1.85)d,术中出血量为(65.85±5.89)mL,少于对照组的(112.38±8.74)mL,组间差异有统计学意义(P<0.05)。观察组术后6、12、24 h的疼痛视觉模拟评分分别为(4.68±0.45)分、(3.58±0.38)分、(2.59±0.34)分,均低于对照组的(6.22±1.04)分、(5.02±0.69)分、(3.82±0.44)分,组间差异有统计学意义(P<0.05)。观察组术后14 d的谷草转氨酶、总胆汁酸、谷丙转氨酶水平分别为(58.63±5.52)U/L、(16.28±2.01)μmol/L、(52.16±5.32)U/L,均低于对照组的(65.27±5.78)U/L、(20.05±2.18)μmol/L、(60.14±5.89)U/L,组间差异有统计学意义(P<0.05)。术后3个月,观察组的世卫组织生活简易量表中生理、心理、社会及环境领域评分分别为(88.24±5.79)分、(86.78±5.29)分、(89.53±5.28)分、(90.36±4.14)分,均高于对照组的(81.27±5.65)分、(80.25±5.21)分、(82.07±5.18)分、(83.62±4.21)分,组间差异有统计学意义(P<0.05)。观察组的并发症发生率为7.14%,低于对照组的23.81%,差异有统计学意义(P<0.05)。结论采用双镜联合经胆囊管钬激光碎石术治疗胆囊结石合并胆总管结石的效果更佳,可减轻机体创伤,促进肝胆功能恢复,且并发症少,值得临床推广使用。

Objective To investigate the application effect of dual mirror combined with transcystic holmium laser lithotripsy in patients with gallstone and choledocholithiasis.Methods 84 patients with gallstone and choledocholithiasis admitted to Taierzhuang District People's Hospital of Zaozhuang City from August 2020 to August 2022 were selected as the reseahrc objects,and were divided into two groups according to random number table method,with 42 cases in each group.The control group underwent laparotomy,and the observation group underwent dual mirror combined with transcystic holmium laser lithotripsy.The operation status,pain score,liver and bile function indexes,quality of life and complications were compared between the two groups.Results The postoperative exhaust time,getting out of bed time and hospitalization time in the observation group were(32.54±3.58)h,(1.65±0.24)d and(8.96±1.12)d,which were shorter than(58.52±5.12)h,(3.42±0.45)d and(12.41±1.85)d in the control group,the intraoperative blood loss was(65.85±5.89)mL,less than(112.38±8.74)mL in the control group,and the differences between the groups were statistically significant(P<0.05).6,12 and 24 h after surgery,the visual analogue scale scores of the observation group were(4.68±0.45)points,(3.58±0.38)points and(2.59±0.34)points,respectively,which were lower than(6.22±1.04)points,(5.02±0.69)points and(3.82±0.44)points of the control group,the differences between the groups were statistically significant(P<0.05).14 days after surgery,the levels of aspartate transaminase,total bile acid and alanine transaminase in the observation group were(58.63±5.52)U/L,(16.28±2.01)μmol/L and(52.16±5.32)U/L,respectively,which were lower than(65.27±5.78)U/L,(20.05±2.18)μmol/L,(60.14±5.89)U/L in the control group,and the differences between the groups were statistically significant(P<0.05).3 months after surgery,the World Health Organization quality of life-BREF scale scores of physiological,psychological,social and environmental fields in the observation group were(88.24±5.79)points,(86.78±5.29)points,(89.53±5.28)points,(90.36±4.14)points,respectively,which were higher than(81.27±5.65)points,(80.25±5.21)points,(82.07±5.18)points and(83.62±4.21)points in the control group,and the differences between the groups were statistically significant(P<0.05).The incidence of complications in the observation group was 7.14%,lower than 23.81%in the control group,and the difference was statistically significant(P<0.05).Conclusion Dual mirror combined with transcystic holmium laser lithotripsy in patients with gallstone and choledocholithiasis is more effective,can reduce body trauma,promote the recovery of liver and bile function,and has fewer complications,and is worthy of clinical promotion.