腹腔镜胆总管切开取石Ⅰ期缝合术与T管引流术治疗高龄胆总管结石患者的效果比较

Comparison of the effects of laparoscopic choledocholithotomy with primary suture and T-tube drainage in the treatment of elderly patients with choledocholithiasis

目的比较腹腔镜胆总管切开取石Ⅰ期缝合术与T管引流术治疗高龄胆总管结石患者的效果。方法将40例高龄胆总管结石患者随机分为对照组(n=20,腹腔镜胆总管切开取石T管引流术)和观察组(n=20,腹腔镜胆总管切开取石Ⅰ期缝合术)。比较两组的结石清除情况、术后并发症发生情况、肝功能指标、应激反应指标、炎症因子、CA19-9水平及生活质量评分。结果两组的结石清除率比较,差异不显著(P>0.05)。观察组的术后并发症总发生率显著低于对照组(P<0.05)。术后3 d,两组的TBIL、ALP、ALT、AST、γ-GT水平均降低,PAB水平均升高,且观察组优于对照组(P<0.05)。术后3 d,观察组的Cor、C-P、ACTH、CRP、PCT、CA19-9水平均显著低于对照组,差异具有统计学意义(P<0.05)。术后1个月,两组的QOL评分均较术前显著升高,且观察组高于对照组(P<0.05)。结论腹腔镜胆总管切开取石Ⅰ期缝合术治疗高龄胆总管结石患者对机体应激反应和肝功能影响小,结石清除率高,能显著改善患者的生活质量。

Objective To compare the effects of laparoscopic choledocholithotomy with primary suture and T-tube drainage in the treatment of elderly patients with choledocholithiasis.Methods Forty elderly patients with choledocholithiasis were randomly divided into control group(n=20,laparoscopic choledocholithotomy with T-tube drainage)and observation group(n=20,laparoscopic choledocholithotomy with primary suture).The stone clearance,postoperative complications,liver function indexes,stress response indexes,inflammatory factors,CA19-9 levels and quality of life score were compared between the two groups.Results There was no significant difference in stone clearance rate between the two groups(P>0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).Three days after operation,the levels of TBIL,ALP,ALT,AST andγ-GT in the two groups decreased,the level of PAB increased,and those in the observation group were better than the control group(P<0.05).Three days after operation,the levels of Cor,C-P,ACTH,CRP,PCT and CA19-9 in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).One month after operation,the QOL score of the two groups was significantly higher than that before operation,and that of the observation group was higher than the control group(P<0.05).Conclusion Laparoscopic choledocholithotomy with primary suture in the treatment of elderly patients with choledocholithiasis has little effect on stress response and liver function,high stone clearance rate,and can significantly improve the quality of life of patients.