腹腔镜胆总管切开取石术对患者应激反应及预后的影响

Effect of laparoscopic common bile duct lithotomy on patients＇ stress reaction and prognosis

目的探讨腹腔镜胆总管切开取石术对患者应激反应及预后的影响。方法收集胆总管结石患者104例，根据手术方式分为OCBDE组和LCBDE组，各52例。OCBDE组采用OCBDE治疗，LCBDE组采用LCBDE治疗。比较两组患者术前、术后第1、3、5天时的血清Cor、C—P、FT3及外周血CD3＋、CD4＋、CD8＋含量及CD4＋／CD8＋比值变化情况；同时比较两组患者术后出血、切口感染、切口裂开、胆瘘、腹腔脓肿、肠梗阻等并发症发生情况。结果两组术后第1天，血清Cor、C—P均较术前明显升高，达峰值，术后第3、5天逐渐降低（P〈0．05），术后第1天血清FT3水平较术前明显降低，术后第3、5天逐渐升高（均P〈0．05）；OCBDE组在术后第5天时，血清Cor、C—P水平仍明显高于术前（P〈0．05），血清FT3水平仍低于术前水平（P〈0．05）；LCBDE组术后第1、3、5天时的血清Cor、C—P水平均明显低于OCBDE组，血清FT3水平明显高于OCBDE组（均P〈0．05）。术后第1天时，两组CD4＋含量、CD4＋／CD8＋比值均明显低于术前，而LCBDE组的CD4＋／CD8＋比值明显低于OCBDE组（均P〈0．05）；术后第3天时，两组CD3＋、CD4＋含量及CD4＋／CD8＋比值均明显低于术前，而LCBDE组的CD3＋、CD4＋含量明显高于OCBDE组（均P〈0．05）；术后第5天时，两组CD3＋、CD4＋含量及CD4＋／CD8＋比值均比术后第3天明显升高，但两组比较差异无统计学意义（P〉0．05）。LCBDE组术后并发症总发生率为28．85％，明显低于OCBDE组的9．62％（P〈0．05）。结论LCBOE对胆总管结石患者所引起的应激反应较轻，细胞免疫功能较稳定，术后并发症发生率较低，预后较好，是胆总管结石患者较好的治疗方法。

Objective To investigate the effect laparoscopic common bile duct lithotomy on the patients＇ stress reaction and prognosis. Methods 104 patients with choledocholithiasis were collected and divided into an OCBDE group and an LCBDE group, 52 cases for each group. The OCBDE group were treated with OCBDE and the LCBDE group with LCBDE. The serum levels of Cor, C-P, and FT3, peripheral blood contents of CD3＋, CD4＋, and CD8＋, and CD4＋/CD8＋ ratio before and day 1, 3, and 5 after the operation were compared between the two groups. At the same time, the occurrences of complications, such as postoperative bleeding, wound infection, wound dehiscence, biliary fistula, abdominal abscess, and intestinal obstruction, were compared between the two group. Results The serum levels of Cor and C-P were higher 1 day after than before the operation and got to the peaks and decreased on day 3 and 5 after the operation （P 〈 0.05） and the serum level of FT3 was lower l day after than before the operation and increased on day 3 and 5 after the operation （P 〈 0.05） in these two groups. The serum levels of Cor and C-P were higher and the serum level of FT3 were lower day 5 after than before the operation in the OCBDE group （ all P 〈 0.05 ）. Day I, 3, and 5 after the operation, the serum levels of Cor and C-P were lower and the serum level of FT3 was higher in the LCBDE group than in the control group （ all P 〈 0.05 ）. Day 1 after the operation, the CD4＋ content and CD4＋/CD8＋ were lower than those before the operation in both groups and the CD4＋/CD8＋ was lower in the LCBDE group than in the OCBDE group （all P 〈 0.05）. Day 3 after the operation, the contents ofCD3＋ and CD4＋ and CD4＋/CD8＋ were lower than those before the operation in both groups and the contents of CD3＋ and CD4＋ were higher in the LCBDE group than in the OCBDE group （all P 〈 0.05）. Day 5 after the operation, the contents of CD3＋ and CD4＋ and CD4＋/CD8＋ were higher than those day 3 after the operation （ all P 〈 0.05 ） but with no statistical differences between these two groups （ all P 〉 0.05 ）. The incidence of postoperative complications was 28.85% in the LCBDE group and was 9.62% in the OCBDE group （P 〈 0.05）. Conclusion For patients with choledocholithiasis, LCBOE has mild stress reaction, stable cellular immune function, low incidence of complication, and good prognosis, so it is a good treatment for patients with choledocholithiasis.