完全腹腔镜下胆总管探查术治疗老年复杂性肝胆管结石的效果及对炎性应激反应指标与免疫功能的影响

Effects of Complete Laparoscopic Common Bile Duct Exploration on Elderly Patients with Complicated Hepatolithiasis and Their Inflammatory Stress Response Index and Immune Function

目的研究完全腹腔镜下胆总管探查术治疗老年复杂性肝胆管结石疗效及对炎性应激反应指标与免疫功能的影响。方法选取我院64例老年(≥60岁)复杂性肝胆管结石患者,随机平均分为2组,32例行完全腹腔镜下胆总管探查术治疗者归为腹腔镜组,32例行传统开腹手术者归为开腹组,比较两组疗效。结果腹腔镜组手术时间、术中出血量、术后肛门排气时间、住院时间和医疗费用均短于或少于开腹组(P<0.05);术后1个月,两组总胆红素、直接胆红素、间接胆红素水平均显著下降(P<0.05),且开腹组下降幅度小于腹腔镜组(P<0.05);术后24h,两组EP、CO、IL-6和CRP水平均显著上升,NK水平显著下降,CD3^+、CD4^+、CD8^+和CD4^+/CD8^+均显著降低,且开腹组变化幅度小于腹腔镜组,差异具有统计学意义(P<0.05);腹腔镜组术后并发症总发生率9.38%,复发率6.25%,开腹组为25%和15.63%,两组差异不具有统计学意义(P>0.05);术后并发症、复发者免疫应激指标与治疗有效者比较差异显著(P<0.05)。结论完全腹腔镜下胆总管探查术治疗老年复杂性肝胆管结石疗效可靠,具有微创、手术时间短、术后恢复快、对患者术后应激反应和免疫功能影响小的特点,可降低术后并发症和复发率,临床推广价值高。

Objective To study the effects of complete laparoscopic common bile duct exploration on elderly patients with complicated hepatolithiasis and their inflammatory stress response index and immune function. Methods 64 cases of the elderly patients（ over 60 years old） diagnosed with complicated hepatolithiasis in our hospital were selected and randomly divided into two groups. 32 cases of patients treated with complete laparoscopic common bile duct exploration was enrolled in the laparoscopic group, and the other 32 cases treated with traditional open surgery were classified as the open group. The curative effects of the two groups were compared. Results The operation time, intra-operative blood loss, postoperative anal exhaust time, hospital stays and medical costs in the laparoscopic group were shorter or less than those in the open group （ P 〈 0.05 ）. The levels of total bilirubin, direct bilirubin and indirect bilirubin of two groups one month after the operation were significantly decreased （ P 〈 0.05 ）, and the declines in the open group was lower than those of the laparoscopic group （ P 〈 0.05 ）. The levels of EP, CO, IL- 6 and CRP in the two groups were significantly increased while the levels of CD3^＋, CD4^＋, CD8^＋ and CD4^＋/CD8^＋ were significantly decreased, and the changes in the open group were significantly higher than those of the laparoscopic group （P 〈 0.05 ）. The total incidence rates of postoperative complications in the laparoscopic group and the open group were 9.38% and 25% respectively, and the recurrence rates were 6.25% and 15.63% respectively, indicating the difference was not statistically significant （P 〉 0.05 ）. There were significant differences in immunological stress index between the complication, relapse cases and therapeutic cases （P 〈 0. 05 ）. Conclusion Complete laparoscopic common bile duct exploration has reliable effects in treatment of elderly patients with complicated hepatolithiasis with the benefits of minimal invasion, short operation time, rapid postoperative recovery, small influence on stress response and improved immune function in patients after the operation. It can also reduce the postoperative complications and the recurrence rate. Therefore, complete laparoscopic common bile duct exploration has a high value in clinical promotion.