双镜联合微创手术治疗胆道结石的效果及对患者胃肠道功能和胆道压力的影响

Effect of double endoscopy combination minimally invasive surgery in the reatment of biliary calculi and its influences on gastrointestinal function and bile duct pressure of patients

目的探讨双镜联合微创手术治疗胆道结石的效果及对患者胃肠道功能和胆道压力的影响。方法将88例胆道结石患者以便利取样法分为观察组(n=44,双镜联合微创手术)和对照组(n=44,开腹手术)。比较两组的治疗效果。结果术后5 d,观察组的VIP水平低于对照组及术后1 d,CCK、MTL水平高于对照组及术后1 d(P<0.05)。术后5 d,两组患者的胆道压力均低于术后1 d,且观察组低于对照组(P<0.05)。手术后,两组患者的CRP、IL-1β及TNF-α水平均低于手术前,且观察组低于对照组(P<0.05)。观察组的住院时间、下床活动时间、手术时间均短于对照组,术中出血量少于对照组,结石清除率高于对照组,并发症总发生率低于对照组(P<0.05)。结论应用双镜联合微创手术治疗胆道结石患者,有利于提高结石清除率,改善患者的胃肠道功能,降低胆道压力,减轻炎症反应,促进患者恢复,减少并发症的发生。

Objective To explore the effect of double endoscopy combination minimally invasive surgery in the treatment of biliary calculi and its influences on gastrointestinal function and bile duct pressure of patients.Methods Eighty-eight patients with biliary calculi were divided into observation group(n=44,double endoscopy combination minimally invasive surgery)and control group(n=44,open surgery)by convenient sampling method.The therapeutic effects of the two groups were compared.Results At 5 days after operation,the VIP level in the observation group was lower than that in the control group and at 1 day after operation,while the levels of CCK and MTL were higher than those in the control group and at 1 day after operation(P<0.05).At 5 days after operation,the bile duct pressure of the two groups were lower than those at 1 day after operation,and that of the observation group was lower than the control group(P<0.05).After operation,the levels of CRP,IL-1βand TNF-αin the two groups were lower than those before operation,and those in the observation group were lower than the control group(P<0.05).The hospitalization time,ambulation time and operation time of the observation group were shorter than those of the control group,the intraoperative blood loss volume was less than that of the control group,the stone clearance rate was higher than that of the control group,and the total incidence of complications was lower than that of the control group(P<0.05).Conclusion Double endoscopy combination minimally invasive surgery in the treatment of patients with biliary calculi can increase the stone clearance rate,improve the gastrointestinal function of patients,decrease the pressure of biliary tract,reduce the inflammatory reaction,promote the recovery of patients and reduce the occurrence of complications.