腹腔镜下胆总管探查术联合一期缝合与经胆囊管胆总管探查术治疗胆总管结石临床对比研究

Clinical study of comparison of LCBDE and primary suture with LTCBDE in treatment of choledocholithiasis

目的探讨腹腔镜下胆总管探查术+一期缝合与腹腔镜下经胆囊管胆总管探查术治疗胆总管结石临床疗效及安全性差异。方法选取2015年5月至2017年5月南阳市医学高等专科学校第一附属医院收治的150例胆总管结石患者,以随机数字表法分为对照组(75例)和观察组(75例)。对照组患者采用腹腔镜下胆总管探查术+一期缝合,观察组患者采用腹腔镜下经胆囊管胆总管探查术治疗;比较两组患者手术用时、术中失血量、术后引流量、术后置管时间、住院时间、T淋巴细胞亚群水平及术后并发症发生率。结果观察组患者手术用时、术中失血量、术后引流量、术后置管时间及住院时间均少于对照组,差异有统计学意义(P<0.05);观察组患者手术前后T淋巴细胞亚群水平比较,差异无统计学意义(P>0.05);观察组患者术后CD3+、CD4+及CD4+/CD8+水平均高于对照组,差异有统计学意义(P<0.05);观察组患者术后CD8+水平低于对照组,差异有统计学意义(P<0.05);观察组患者术后并发症发生率低于对照组(20.00%vs 4.00%),差异有统计学意义(P<0.05)。结论腹腔镜下经胆囊管胆总管探查术治疗胆总管结石可有效降低手术创伤,加快病情康复进程,提高细胞免疫功能,且有助于降低术后并发症风险,优于腹腔镜下胆总管探查术+一期缝合。

Objective To investigate the clinical efficacy and safety difference of laparoscopic common bile duct exploration（ LCBDE） and primary suture and laparoscopic transcystic common bile duct exploration（ LTCBDE） in the treatment of patients with choledocholithiasis. Methods 150 patients with choledocholithiasis ever treated in our hospital between May 2015 and May 2017 were chosen,and then divided into the control group（ 75 cases） and the study group（ 75 cases） by means of random number table. Patients in the control group underwent LCBDE and primary suture of bile duct,and the study group was treated with LTCBDE. Then the operation duration,intraoperative blood loss,postoperative drainage,postoperative intubation time,hospitalization duration,together with blood levels of T lymphocyte subsets and incidence of postoperative complications,were recorded and compared. Results The operation duration,intraoperative blood loss,postoperative drainage,postoperative intubation time and hospitalization duration in the study group were significantly shorter or lower than those in the control group（ P〈0. 05）. There was no significant difference in the blood levels of T lymphocyte subsets before and after operation in the study group（ P〉0. 05）. The blood levels of CD3^＋,CD4^＋and CD4^＋/CD8^＋after operation in the study group were significantly higher than those in the control group（ P〈0. 05）,but the CD8^＋level after operation in the study group was significantly lower than that in the control group（ P〈0. 05）. The incidence of postoperative complications in the study group was also significantly lower than that in the control group（ 20. 00% vs 4. 00%,P〈0. 05）. Conclusion Application of the LTCBDE operation in treatment of those patients with choledocholithiasis could effectively lessen surgical trauma,fasten postoperative recovery,improve cellular immune function,and help to reduce risk of postoperative complications,which might be superior to the operation of LCBDE and primary suture.