腹腔镜微创与传统开腹胆道取石治疗胆总管结石的效果分析

Clinical efficacy of endoscope minimally invasive surgery and choledochofiberscopy on choledocholithiasis and their impact on the oxidative stress and immune function

目的比较腹腔镜微创与传统开腹胆道取石治疗胆总管结石的效果及对患者机体氧化应激和免疫功能的影响。方法选择该院2015年7月-2017年12月收治的90例胆总管结石患者,利用随机数字表将其分成微创组与开腹组两组,每组各45例。其中微创组给予腹腔镜联合胆道镜治疗,开腹组给予传统开腹胆道取石术治疗,比较两组手术疗效及手术前后氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)]和免疫功能指标[CD3^+、CD4^+、CD8^+T细胞百分率及CD4^+和CD8^+T细胞比值(CD4^+/CD8^+比值)]的变化。结果微创组手术时间和术中出血量明显低于开腹组(P <0.05),两组结石取净率比较,差异无统计学意义(P>0.05)。微创组术后肠鸣音恢复、肛门排气和住院时间明显低于开腹组(P <0.05)。微创组术后12 h时视觉模拟评分(VAS)、术后镇痛药使用率和并发症发生率明显低于开腹组(P <0.05)。微创组手术前后血清SOD、MDA和GSH-Px比较,差异无统计学意义(P>0.05);开腹组术后第1天时血清SOD和GSH-Px活性明显低于术前,MDA水平明显高于术前(P <0.05)。两组术后第1天时外周血CD3^+、CD4^+、CD8^+及CD4^+/CD8^+比值明显低于术前(P <0.05),其中开腹组降低更明显(P <0.05)。结论腹腔镜微创与传统开腹胆道取石治疗胆总管结石均能取得较好的取石效果,但腹腔镜微创手术对机体创伤更小,不会引起明显的氧化应激反应,对机体免疫功能影响小,术后恢复快。

Objective To compare the clinical efficacy on choledocholithiasis between endoscope minimally invasive surgery and choledochofiberscopy and its impact on the oxidative stress and immune function in patients.Methods The subjects of this study,90 patients with choledocholithiasis from July 2015 to December 2017,were divided into minimally invasive group and open surgery group,45 cases in each.The minimally invasive group was treated with endoscope minimally invasive surgery,while the open surgery group choledochofiberscopy.The clinical efficacy and changes of oxidative stress parameters[superoxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px)]and immune function indicators[percentage of CD3+,CD4+,CD8+T and CD4+/CD8+value]before and after operation were compared between the two groups.Results The minimally invasive group had much shorter operation duration and less intraoperative blood loss than the open surgery group did(P<0.05),seeing no difference from the latter in terms of stone-free rate(P>0.05).The minimally invasive group took a shorter time in resuming body temperature,bowel sounds,flatus and hospital stay than the open surgery group did(P<0.05).The VAS scores 12 h after operation,use of analgesics and incidence of complications of the minimally invasive group were much lower than those of the open surgery group(P<0.05).No big difference was seen in serum SOD,MDA,GSH-Px of the minimally invasive group after operation as compared with those before operation(P>0.05).1 d after operation the open surgery group obtained much lower activity of serum SOD and GSH-px and higher MDA level as compared with those before treatment(P<0.05).1 d after operation both groups saw a remarkable decrease in peripheral blood CD3+,CD4+,CD8+and CD4+/CD8+value as compared with those before operation(P<0.05),and the decrease of the open surgery group was more significant(P<0.05).Conclusion In treating choledocholithiasis,both endoscope minimally invasive surgery and choledochofiberscopy are effective,but the former gives advantages of less trauma to the body,less oxidative stress and impact on the immune function,and quicker recovery.