腹腔镜联合胆道镜钬激光碎石术对胆管结石患者胃肠功能及应激炎性反应的影响

Effects of laparoscopy combined with cholangioscopic holmium laser lithotripsy on gastrointestinal function and inflammation stress response in cholangiolithiasis patients

目的探讨腹腔镜联合胆道镜钬激光碎石术对患者术后胃肠功能及炎性应激反应的影响。方法选取2017年1月—2019年9月汕头市潮阳区大峰医院普外科收治的胆管结石患者90例,随机数字表法分为对照组和观察组各45例,对照组采用传统开腹取石手术,观察组给予腹腔镜联合胆道镜钬激光碎石手术,记录2组患者围术期指标,比较2组患者肠胃功能指标、血清应激反应指标、炎性因子水平、术后并发症发生率及结石残留率。结果观察组患者的手术时间、术中出血量、术后排气时间、首次排便时间及住院时间均短于对照组(t=8.850、29.560、5.787、7.417、6.346,P均<0.01);术后7 d,观察组白细胞计数(WBC)、中性粒细胞计数(N)、皮质醇(CO)、肾上腺素(EP)水平均低于对照组(t=14.983、5.302、9.073、18.852,P均<0.01),白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平亦均低于对照组(t=32.932、10.553、17.139,P均<0.01);观察组并发症发生率、结石残留率均低于对照组(χ^2=4.406、5.075,P均<0.05)。结论与传统开腹手术相比,腹腔镜联合胆道镜钬激光碎石术可显著改善术后胃肠功能指标,对患者血清氧化应激指标和炎性指标影响较小,有助降低并发症发生率和结石残留率。

Objective To explore the effects of laparoscopy combined with cholangioscopic holmium laser lithotripsy(HLL)on postoperative gastrointestinal function and inflammation stress response in cholangiolithiasis patients.Methods Ninety cholangiolithiasis patients who were admitted to Dafeng Hospital in Shantou from January 2017 to March 2019 were enrolled.They were divided into control group and experimental group by random number table method,45 cases in each group.The control group underwent traditional laparotomy,while experimental group underwent laparoscopy combined with cholangioscopic HLL.The gastrointestinal function indexes,serum stress response indexes,levels of inflammatory factors,postoperative stone residual rate and incidence of complications were compared between the two groups.Results The operation time,intraoperative blood loss,postoperative exhaust time,first defecation time and hospitalization days in experimental group were shorter than those in control group(t=8.850,29.560,5.787,7.417,6.346,P<0.01).At 1d after surgery,levels of white blood cell count(WBC),neutrophil count(NEUT),cortisol(CO)and epinephrine(EP)in experimental group were lower than those in control group(t=14.983,5.302,9.073,18.852,P<0.05),and levels of interleukin(IL)-6,tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)were lower than those in control group(t=32.932,10.553,17.139,P<0.05).The incidence of complications and stone residual rate in experimental group were lower than those in control group(χ^2=4.406,5.075,P<0.05).Conclusion Compared with traditional laparotomy,laparoscopy combined with cholangioscopic HLL can significantly improve postoperative gastrointestinal function indexes,with few effects on their serum oxidative stress indexes and inflammation indexes,which is conducive to decreasing incidence of complications and stone residual rate.