腹腔镜胆囊切除胆道探查术治疗胆囊结石并发胆总管结石的研究

Clinical research on laparoscopic cholecystectomy with common bile duct exploring in the treatment of cholecystolithiasis with choledocholithiasis

目的:研究腹腔镜胆囊切除胆道探查术(laparoscopic cholecystectomy common bile duct exploration,LCCBDE)治疗胆囊结石并发胆总管结石(cholecystolithiasis with choledocholithiasis,CWC)的临床效果。方法:收集106例CWC患者的临床资料,依据手术方式不同分为LCCBDE组(n=53)与对照组(n=53)。LCCBDE组行LCCBDE治疗,对照组行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗。观察两组患者术中失血量、手术时间、肠鸣音恢复时间、术后肛门排气时间、住院费用及住院时间、结石一次清除、术后并发症,治疗前后血清T淋巴细胞及炎性因子水平。结果:LCCBDE组手术时间、肠鸣音恢复时间、术后肛门排气时间、住院费用及住院时间均小于对照组,差异均有统计学意义(P<0.05);术后并发症发病率(9.43%)小于对照组(24.53%),差异有统计学意义(P<0.05);术前与术后7 d LCCBDE组患者CD3^+、CD4^+、CD8^+差值、CRP、TNF-α、IL-6差值均大于对照组,差异均有统计学意义(P<0.05);LCCBDE组结石一次清除率(92.45%)与对照组(86.79%)差异无统计学意义(P>0.05)。结论:LCCBDE治疗CWC有利于患者术后康复,快速纠正免疫失衡,减小炎性反应,术后并发症发生率低,值得临床应用。

Objective：To investigate the clinical effect on cholecystolithiasis with choledocholithiasis （CWC） using laparoscopic cholecystectomy common bile duct exploration （LCCBDE）.Methods：A total of 106 cases of patients were selected as the research objects,and divided into LCCBDE group （n = 53） and control group （n = 53） in accordance with the way of the operation.Patients in LCCBDE group were performed LCCBED therapy,patients in control group were performed laparoscopic cholecystectomy （LC） therapeutic method.The blood loss in operation,time of operation,time of resuming peristaltic sound,anus exhausting time after operation,the hospitalized time and fee,stone free rates,postoperative complication rates,levels of T-lymphocyte in serum and inflammatory factor before and after the treatment of patients in two groups were observed.Results：The time of operation,time of resuming peristaltic sound,anus exhausting time after operation,the hospitalized time and fee of LCCBDE group were less than those in control group,and the differences were statistically significant （P〈0.05）.The postoperative complication rates （9.43%） was lower than that in control group （24.53%）,the difference was statistically significant （P〈0.05）.Differences of 7 d CD3-＋、CD4-＋、CD8-＋ and differences of CRP、TNF-α、IL-6 before and after the treatment were larger than those in control group,and the differences were statistically significant （P〈0.05）.The difference of stone free rate between LCCBDE group （92.45%） and control group （86.79%） was not statistically significant （P〈0.05）.Conclusion：Using LCCBDE to treat CWC is beneficial to patients＇ postoperative rehabilitation and it can correct immune imbalance rapidly and reduce the inflammatory reaction.The rate of complications after operation is low.It is worth application clinically.