腹腔镜下经胆囊管胆道镜探查取石术的临床研究及术后感染的影响因素分析

Clinical study on laparoscopic common bile duct exploration combined choledochoscopic examination and risk factors of postoperative infection

目的探讨腹腔镜下经胆囊管胆道镜探查取石术的临床应用价值及其术后感染的影响因素。方法选择2013年4月-2016年10月医院收治的胆囊结石伴胆总管结石患者60例为研究对象,根据胆道镜不同探查入径分为研究组与对照组,每组30例。对照组行腹腔镜胆囊切除术+胆总管切开取石术+T管引流术;研究组行腹腔镜胆囊切除术+胆道镜经胆囊管胆道探查取石术。观察两组手术成功率、中转开腹率、手术时间、术后引流管放置时间、术后排气时间、住院费用、术后并发症等。全自动生化分析仪检测患者术后1d及术后3d时血常规。ELISA法检测患者术后1d及3d时血中降钙素原(PCT)水平变化情况。进行术后感染的单因素、多因素分析。结果研究组手术时间、引流管放置时间、首次排气时间分别为(155.2±16.3)min、(31.5±3.0)d、(2.6±0.3)d,均短于对照组的(205.4±22.1)min、(62.3±5.7)d、(3.3±0.4)d(P<0.05);研究组住院费用为(22635.3±2365.4)元,少于对照组的(33567.7±3102.8)元(P<0.05);研究组术后1d及3d时,血中白细胞计数、中性粒细胞百分比、PCT水平均低于对照组(P<0.05);多因素Logistic回归分析结果显示,年龄、手术时间均为术后感染的影响因素。结论腹腔镜联合胆道镜经胆囊管胆道探查取石术安全有效,能够缩短住院时间,降低机体炎症水平,改善患者术后感染状态,值得进一步开展。

OBJECTIVE To explore the clinical value of laparoscopic common bile duct exploration combined choledochoscopic examination and risk factors of postoperative infection.METHODS A total of 60 cases of patients with gallbladder stones and choledocholithiasis from Apr.2013 to Oct.2016 were selected,and were divided into the study group and the control group according to different exploration entry methods of choledochoscope,with 30 cases in each group.The control group underwent laparoscopic cholecystectomy ＋ choledochotomy ＋ T tube drainage.The study group was performed on laparoscopic cholecystectomy＋ biliary tract through cholecystectomy.The success rates,laparotomy rate,operation time,postoperative drainage tube placement time,discharge time,hospitalization expense,and the postoperative complications of the two groups were observed.Automatic biochemical analyzer was used to detect the blood routine at 1 day and 3 days after surgery.ELISA method was used to detect the changes of the level of calcitonin（PCT）in the blood at 1 day and 3 days after surgery.Univariate and multivariable analysis of postoperative infection were carried out.RESULTS The operation time,the placement time of the drainage tube and the first exhaust time of the study group were（155.2±16.3）min,（31.5±3.0）d,and（2.6±0.3）d,which were significantly shorter than（205.4±22.1）min,（62.3±5.7）d,and（3.3±0.4）d of the control group（P〈0.05）.The hospitalization cost of the study group was（22635.3±2365.4）yuan,which was significantly lower than（33567.7±3102.8）yuan of the control group（P〈0.05）.At the first day and three days after surgery,the blood cell counts,percentage of neutrophils and the PCT of the study group were significantly lower than those of the control group（P〈0.05）.Multivariable logistic regression analysis showed that age and operation time were risk factors for postoperative infections.CONCLUSIONLaparoscopic common bile duct exploration combined choledochoscopic examination is safe and effective,it can shorten the hospitalization time,reduce the inflammation level of the body,and improve the postoperative infection status of the patient,which is deserved further development.