双镜联合微创手术治疗老年胆囊结石合并胆总管结石的临床分析

Clinical Analysis of Dual-Endoscopy Combined Minimally Invasive Surgery in the Treatment of Elderly Patients with Cholecystolithiasis and Choledocholithiasis

目的研究双镜联合微创手术对老年胆囊结石合并胆总管结石的治疗效果,以及观察该手术方法对老年患者血清炎性因子及尿胰蛋白酶原-2水平的影响,为治疗该病症提供方法。方法回顾性分析2017年1月-2020年8月在乐山市人民医院肝胆胰脾外科住院治疗的268例老年胆囊结石合并胆总管结石患者的临床资料,根据治疗方法不同分为观察组(n=154)和对照组(n=114)。照组采用常规开腹手术进行治疗,观察组采用内镜下十二指肠乳头括约肌切开术(endoscopic sphieterotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的双镜联合微创手术进行治疗。观察并比较2组患者基本手术指标、结石遗留情况、术后血清炎性因子和尿胰蛋白酶原-2水平、肝功能指标[总胆红素(TBIL)、结合胆红素(DBIL)、门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)]和并发症情况。结果观察组术中出血量、手术时间、住院时间及肠胃功能恢复时间均明显少于对照组,差异具有统计学意义(P<0.05);观察组术后血清白介素-6(interleukin 6,IL-6)及C反应蛋白(C-reactive protein,CRP)、尿胰蛋白酶原-2、TBIL、D BIL、AST和ALT水平均低于对照组(P<0.05);观察组术后并发症发生率显著低于对照组(P<0.05);观察组结石遗留率低于对照组,但差异无统计学意义(P>0.05)。结论与常规开腹手术相比,双镜联合微创手术治疗老年胆囊结石合并胆总管结石患者具有较好的疗效,引起的炎性反应更轻,并发症更少,可用于治疗老年胆囊结石合并胆总管结石患者。

Objective To study the therapeutic effect of dual-endoscopy combined minimally invasive surgery on cholecystolithiasis and choledocholithiasis in the elderly patients,and observe the effect of this surgical method on serum inflammatory factors and urine trypsinogen-2 levels of the elderly patients,and provide references for the treatment of this disease.MethodsAtotal of 268 elderly patients with cholecystolithiasis and choledocholithiasis who were hospitalized in the Department of Hepatobiliary Pancreatic Spleen Surgery of People's Hospital of Leshan City from January 2017 to August 2020 were retrospectively analyzed.According to different treatment methods,the patients were divided into observation group(n=154)and control group(n=114).The patients of control group were treated with conventional open surgery,while the ones of the observation group were treated with endoscopic sphincterotomy(EST)combined with laparoscopic cholecystectomy(LC).The basic surgical indicators,stone retention,postoperative serum inflammatory factors and urine trypsinogen-2 levels,liver function indicators[total bilirubin(TBIL),conjugated bilirubin(DBIL),aspartate acid aminotransferase(AST),alanine aminotransferase(ALT)]and complications were compared between the two groups.Results The intraoperative blood loss,operation time,hospitalization time and recovery time of gastrointestinal function of the observation group were less than those of the control group(P<0.05).The levels of seruminterleukin-6(IL-6),C-reactive protein(CRP),urinary trypsinogen-2,TBIL,DBIL,AST and ALT of the observation group were lower than those of the control group(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group.The stone retention rate in the observation group was lower than that in the control group,but the difference was not statistically significant(P>0.05).Conclusions Compared with conventional open surgery,dual-endoscopy combined minimally invasive surgery in the treatment of elderly patients with cholecystolithiasis and choledocholithiasis has better curative effect,less inflammatory reaction and fewer complications.