腹腔镜联合胆道镜保胆取石术和腹腔镜胆囊切除术治疗老年胆囊结石的对比临床研究

A comparative clinical study of laparoscopy combined with choledochoscope gallbladder sparing stone removal and laparoscopic cholecystectomy in the treatment of cholecystolithiasis in the elderly

目的对比观察腹腔镜联合胆道镜保胆取石术和腹腔镜胆囊切除术治疗老年胆囊结石的疗效及安全性,为更有效地治疗老年胆囊结石提供方法。方法回顾性分析2017年03月—2019年03月四川大学华西广安医院收治的110例老年胆囊结石患者的临床资料,根据治疗方法不同分为观察组(n=60)和对照组(n=50)。观察组采用腹腔镜联合胆道镜保胆取石术治疗,对照组采用腹腔镜胆囊切除术治疗。评估并比较2组的围术期指标值、疼痛程度(NRS评分)、应激反应指标值[血糖、皮质醇(COR)、C反应蛋白(CRP)]、肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBiL)、总蛋白(TP)、碱性磷酸酶(ALP)]、并发症发生率及2年复发率。结果观察组手术时间长于对照组(P<0.05);观察组术后6 h、24 h及48 h的NRS评分均明显低于对照组(P<0.05);观察组术后即刻和术后3 d的血糖、COR、CRP均低于对照组(P<0.05);2组ALT、AST、TBIL、TP、ALP水平及并发症发生率和2年复发率比较差异均无统计学意义(P>0.05)。结论腹腔镜联合胆道镜保胆取石术与腹腔镜胆囊切除术对老年胆囊结石患者肝功能的影响无明显差异,但腹腔镜联合胆道镜保胆取石术可缓解患者的疼痛程度,降低患者的应激反应,是治疗老年胆囊结石较为安全有效的手术方案。

Objective To compare the efficacy and safety of laparoscopic cholecystolithotomy combined with choledochoscope gallbladder sparing stone removal and laparoscopic cholecystectomy in the treatment of cholecystolithiasis in the elderly and provide a more effective method for the treatment of this disease.Methods The clinical data of 110 elderly patients with cholecystolithiasis who were admitted and treated in west China Guang'an hospital between March 2017 and March 2019 were retrospectively analyzed.They were divided into control group(n=50)and observation group(n=60)according to the different treatment method.Patients in the control group were treated with laparoscopic cholecystectomy,while those in the observation group were treated with laparoscopy combined with choledochoscope gallbladder sparing stone removal.The perioperative indexes,pain degree(NRS),stress response indexes[blood glucose,cortisol(COR),C-reactive protein(CRP)],liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBiL),total protein(TP),alkaline phosphatase(ALP)],incidence of complications and 2-year recurrence rate were compared between the two groups.Results The operative time of the observation group was longer than that of the control group(P<0.05).NRS scores of the observation group were lower than those of the control group at 6 h,24 h and 48 h after operation(P<0.05).Blood glucose,COR and CRP of the observation group were lower than those of the control group immediately after operation and at 3 days after operation(P<0.05).There was no significant difference in ALT,AST,TBIL,TP,ALP,incidence of complications and 2-year recurrence rate between the two groups(P>0.05).Conclusion The effect of laparoscopy combined with choledochoscope gallbladder sparing stone removal on liver function of elderly patients with cholecystolithiasis is similar with that of laparoscopic cholecystectomy.However,the former is more effective in relieving pain and reducing stress response of patients,which is a safe and effective surgical scheme for the treatment of elderly patients with cholecystolithiasis.