腹腔镜联合胆道镜保胆手术对胆囊收缩功能的影响

Influence of gallbladder contraction function for gallbladder-preserving cholecystolithotomy by laparoscope combined with choledochoscope

目的 探讨腹腔镜联合胆道镜保胆手术治疗胆囊良性疾病对患者胆囊收缩功能的影响.方法 回顾性分析收治的73例胆囊良性疾病患者,其中31例行腹腔镜胆囊切除术（LC组）,42例行腹腔镜联合胆道镜保胆术（EMIC组）;对两组患者的手术情况、治疗结局及术后并发症进行对比分析;同时,分别于手术前后采用彩色多普勒超声对EMIC组患者的胆囊收缩功能进行定点测试,并在测定同时采取两组患者的空腹肘静脉血,以双抗体夹心法测定胆囊收缩素水平.结果 两组患者均成功完成手术,EMIC组手术时间高于LC组[（84.6±11.4） min比（72.1±13.6） min,t=4.076,P＜ 0.05],但术中出血量有所减少[（11.3±4.8） ml比（19.6±5.5）ml,t=3.715,P＜0.05],术后并发症亦明显降低（2.38％比16.14％,x2=4.469,P＜ 0.05）,且随访期无复发病例.两组患者的术前胆囊收缩素水平比较差异无统计学意义（P＞0.05）,术后1、6、12个月EMIC组分别为（33.6±10.6）、（49.4±12.7）、（63.4±14.6） ng/L,LC组分别为（21.4±9.1）、（11.3±7.4）、（6.7±2.7） ng/L,EMIC组均显著高于LC组（t=3.472,17.514,31.472,P＜0.05或＜0.01）.术后1个月,EMIC组的胆囊收缩率较术前显著减小[（22.8±4.5）％比（39.2±7.6）％,t=6.003,P＜0.05],术后6个月,EMIC组的胆囊收缩率逐渐恢复至术前水平,术后12个月,EMIC组的胆囊收缩率较术前显著升高[（48.8±7.6）％比（39.2±7.6）％,t=3.054,P＜0.01].结论 腹腔镜联合胆道镜保胆取石术可进一步优化内镜手术的微创优势,并且能够在保障结石清除率的基础上维持胆囊的收缩功能,在胆囊良性疾病中具有较高的推广价值.

Objective To explore the influence of gallbladder contraction function for gallbladderpreserving cholecystolithotomy by laparoscope combined with choledochoscope laparoscope.Methods Seventy-three patients with benign gallbladder diseases were selected.Patients treated with laparoscopic cholecystectomy were enrolled in LC group （31 patients）,while those treated with endoscopic minimally invasive cholecystolithotomy （EMIC） were enrolled in EMIC group （42 patients）.Operation situation,treatment outcome and postoperative complications were analyzed between two groups.At the same time,the level of cholecystokinin was detected with double antibody sandwich method in two groups,and the gallbladder contraction function of patients in EMIC group were detected with color Doppler.Results All patients were completed surgery without relapse cases.The operation time in EMIC group was longer than that in LC group：（84.6 ± 11.4） min vs.（72.1 ± 13.6） min,t =4.076,P 〈 0.05.But the intraoperative bleed and postoperative complications in EMIC group were lower than those in LC group：（11.3 ± 4.8） ml vs.（19.6 ± 5.5） ml,t =3.715,P 〈0.05;2.38% vs.16.14%,x2 =4.469,P 〈0.05.There were no recurrence.The levels of cholecystokinin in two groups before operation had no significant difference （P 〉 0.05）.After treatment for 1,6,12 months,the levels of cholecystokinin in EMIC group were （33.6 ± 10.6）,（49.4 ± 12.7）,（63.4 ± 14.6）ng/L,in LC group were （21.4 ± 9.1）,（11.3 ± 7.4）,（6.7 ± 2.7） ng/L,the levels of cholecystokinin in EMIC group were significantly higher than those in LC group （t =3.472,17.514,31.472,P 〈 0.05 or 〈 0.01）.After treatment for 1 month,the rate of gallbladder contraction in EMIC group was significantly lower than that before treatment：（22.8 ± 4.5）% vs.（39.2 ± 7.6）%,t =6.003,P 〈 0.05）.After treatment for 6 months,the rate of gallbladder contraction in EMIC group was recovered,after treatment for 12 months,the rate of gallbladder contraction in EMIC group was significantly higer than that before treatment：（48.8 ± 7.6）% vs.（39.2 ± 7.6）%,t =3.054,P 〈 0.01.Conclusions Gallbladder-preserving cholecystolithotomy by laparoscope combined with choledochoscope can get less iatrogenic trauma,which contribute to a protective effect on gallbladder contraction function on the base of high stone removal rate.It has promotive value in benign gallbladder diseases.