双镜同期治疗胆结石并肝外胆管结石的可行性及对免疫功能的影响

Feasibility of dual-lens simultaneous treatment of gallstones complicated by extrahepatic cholangiolithiasis and its effects on immune function of patients

目的探讨腹腔镜联合胆道镜或十二指肠镜同期治疗胆结石并肝外胆管结石的疗效及对患者免疫功能的影响。方法收治的胆结石并肝外胆管结石患者82例采用随机数字表法分为2组,每组41例。双镜A组采取腹腔镜胆囊切除术(LC)联合胆道镜治疗,双镜B组采取LC联合十二指肠镜治疗。比较2组手术相关指标及术后并发症发生情况,比较2组手术前后T淋巴细胞比例及免疫球蛋白含量。结果 2组患者均顺利完成手术,2组手术时间、术中出血量、结石清除率、结石残留率、中转患者比例、术后下床时间、胃肠功能恢复时间、术后并发症发生率差异均无统计学意义(P>0.05)。与双镜A组比较,双镜B组住院时间明显缩短,但住院费用明显升高(P<0.01)。术后1 d 2组CD+4、CD+8比例及Ig G、Ig A、Ig M较术前降低(P<0.05或<0.01),但2组间差异无统计学意义(P>0.05)。结论 LC联合胆道镜或十二指肠镜治疗胆囊结石并肝外胆管结石均具有较好的临床疗效,但LC联合胆道镜治疗手术费用相对更低,LC联合十二指肠镜的患者术后住院时间更短。

Objective To investigate the therapeutic effects of laparoscopy combined with choledochoscopy or duodenoscopy on gallstones complicated by extrahepatic cholangiolithiasis and its effects on immune function of patients.Methods A total of 82 patients with gallstones complicated by extrahepatic cholangiolithiasis were randomly divided into two groups according to random digital table,with 41 patients in each group. The patients in group A were treated by laparoscopic cholecystectomy（ LC） combined with choledochoscopy,however,the patients in group B were treated by LC combined with duodenoscopy. The operation related indexes,postoperative complications,proportion of T lymphocytes and the levels of immunoglobulin before and after operation were observed and compared between two groups. Results The operation was performed successfully in the patients of both groups,and there were no significant differences in operation time,intraoperative blood loss,stone clearance rate,stone residual rate,the proportion of transit patients,postoperative out of bed time,gastrointestinal function recovery time,postoperative complications between two groups（ P〉0. 05）. As compared with that in group A,the duration of hospitalization in group B was significantly shortened,but the cost of hospitalization was significantly increased（ P〈0. 01）. Moreover the levels of CD＋4,CD＋8 and Ig G,Ig A and Ig M at 1 day after operation were significantly decreased in both groups,as compared with those before operation（ P〈0. 05 or P〈0. 01）,however there were no significant differences between two groups（ P〈0. 05）. Conclusion LC combined with choledochoscopy or duodenoscopy in treatment of gallstones complicated by extrahepatic cholangiolithiasis can obtain better therapeutic effects,but the surgery cost of LC combined with choledochoscopy is relatively lower,and the hospital stay of patients after operation of LC combined with duodenoscopy is shorter.