腹腔镜联合胆道镜经胆囊管治疗胆总管结石的疗效观察

Efficacy of choledochoscope combined with laparoscopy in patients with common bile duct stones

目的观察腹腔镜联合胆道镜经胆囊管治疗胆总管结石的疗效及其对血清C反应蛋白(CRP)、前白蛋白(PA)和总胆红素(TBIL)的影响。方法选取2012年1月至2013年6月在本院诊断和治疗的胆总管结石80例,按照手术方式不同分为腹腔镜联合术中胆道镜经胆囊管胆道探查取石术(LTCBDE)组(45例)和开腹组(35例)。比较两组患者手术时间、术中出血量、术后肛门排气时间、视觉模拟评分法(VAS)评分、并发症发生率,以及两组治疗前后CRP、PA和TBIL水平的变化。结果两组患者均成功进行手术,除手术时间比开腹组长外,LTCBDE组的术中出血量、术后VAS评分、肛门排气时间、术后住院时间和并发症明显少于开腹组(P<0.01)。LTCBDE组的并发症发生率为8.89%,明显低于开腹组的28.57%,差异有统计学意义(P<0.05)。治疗后,两组的CRP和TBIL水平比治疗前明显降低(P<0.01),而PA水平比治疗前明显升高(P<0.01)。LTCBDE组的降低和升高水平比开腹组更为明显(P<0.01)。结论腹腔镜联合胆道镜经胆囊管治疗胆总管结石的疗效确切,可能与CRP、TBIL降低和PA水平的升高有关。

Objective To evaluate the efficacy of choledochoscope combined with laparoscopy in patients with common bile duct stones and its effects on serum C-reactive protein （CRP）, prealbumin （PA） and total bilirubin （TBIL）. Methods 80 patients with common bile duct stones,from January 2012 to June 2013 ,were divided into laparoscopic trancystic common bile duct exploration （LTCBDE） group （45 cases） and laparotomy group （35 cases） in accordance with the modus operandi. The operative time, blood loss, postoperative anal exhaust time, visual analog scale （VAS） score and incidence of complications were evaluated.The levels of CRP, PA and TBIL were measured before and after the treatment. Results All patients were successful operated, the blood loss, postoperative VAS score, anal exhaust time, hospital stay and complications in LTCBDE group were significantly decreased or shortened （P〈0.01）. The complication rate of the LTCBDE group was 8.89%, and 28.57% in the laparotomy group. The complications rates in the LTCBDE group was significantly lower than the laparotomy group （P〈0.05）. After treatment,the levels of CRP and TBIL were significantly reduced （P〈0.01）, while the PA levels appeared to increase （P〈0.01）. The lowering and raising levels of LTCBDE group were more significant compared with the laparotomy group （P〈0.01）. Conclusions The efficacy of choledochoscope combined with laparoscopy by cystic duct in patients with common bile duct stones was obvious. It may be correlated with the levels of CRP, TBIL and PA.