十二指肠镜、腹腔镜联合应用于高龄胆囊结石并肝外胆管结石的效果分析

The effect of combined duodenoscopy and laparoscopy on gallstone and extrahepatic bile duct stones in elderly patients and its effect on the index of trauma stress

目的探究十二指肠镜、腹腔镜联合应用于高龄胆囊结石并肝外胆管结石的效果及对创伤应激指标的影响。方法选取四川护理职业学院附属医院及四川友谊医院104例行择期手术治疗的胆囊结石并肝外胆管结石高龄患者为研究对象,采用随机数字表法分为十二指肠镜、腹腔镜联合手术组(观察组,n=52)和传统开腹手术组(对照组,n=52)。记录两组手术相关指标(手术时间、术中出血量、肠功能恢复时间、住院时间、镇痛剂使用率)、术后1个月内并发症(胆道出血、胆瘘、急性胰腺炎、切口感染)发生情况差异,并比较两组术前及术后24小时创伤应激指标[超氧化物岐化酶(SOD)、丙二醛(MDA)]差异。结果观察组手术时间较对照组长(P <0. 05),但术中出血量、肠功能恢复时间、住院时间、镇痛剂使用率及术后1个月内并发症总发生率均低于对照组(P <0. 05)。术后24小时时,两组SOD水平均较术前降低(P <0. 05),MDA水平则较术前升高(P <0. 05),且对照组变化幅度大于观察组(P <0. 05)。结论十二指肠镜、腹腔镜联合应用于高龄胆囊结石并肝外胆管结石手术治疗中效果显著,可减轻手术创伤和术后应激反应,并降低术后并发症发生风险,于促进患者康复有积极意义。

Objective To explore the effect of duodenoscopy and laparoscopy on gallstones of gallbladder and extrahepatic bile duct stones in elderly patients and the effect on the index of trauma stress.Methods104elderly patients with elective cholecystolithiasis and extrahepatic bile duct stones were selected from Sichuan nursing Career Academy Affiliated Hospital and Sichuan friendship hospital.They were randomly divided into duodenoscopy and laparoscopy combined operation group(observation group,n=52)and traditional open surgery group(control group,n=52).Two groups of indicators related to the operation records(operation time,intraoperative bleeding,intestinal function recovery time,hospitalization time,complication rate,analgesic use)within1months after surgery(biliary tract bleeding,biliary fistula,acute pancreatitis,wound infection)the occurrence of differences,and compared between the two groups before and after surgery trauma24h stress index[superoxide dismutase(SOD),malondialdehyde(MDA)]difference.Results The operative time in the observation group was longer than that in the control group(P<0.05),but the intraoperative blood loss,bowel function recovery time,hospitalization time,analgesic utilization rate and postoperative complication rate within1months were all lower than those in the control group(P<0.05).At the time of24h,the levels of SOD in the two groups were all lower than those before operation(P<0.05),and the level of MDA was higher than that before operation(P<0.05),and the change in the control group was larger than that in the observation group(P<0.05).Conclusion Duodenoscopy and laparoscopy are effective in the treatment of elderly patients with cholecystolithiasis and extrahepatic bile duct stones,which can reduce operative trauma and postoperative stress response,and reduce the risk of postoperative complications,which is of positive significance in promoting the rehabilitation of patients.