纤维胆道镜联合腹腔镜治疗肝外胆管结石的效果及对炎症因子与肾素血管紧张素系统活性的影响

Effects of fiberoptic choledochoscope combined with laparoscopy in the treatment of extrahepatic bile duct stones and its influence on inflammatory factors and renin-angiotensin system activity

目的:探讨纤维胆道镜联合腹腔镜治疗肝外胆管结石的效果及对炎症因子与肾素血管紧张素系统(renin-angiotensin system,RAS)活性的影响。方法:采用多中心、双盲、随机、双模拟与平行对照前瞻性方式对2018年1月至2019年12月郑州市第七人民医院收治的98例肝外胆管结石患者进行研究。以随机数字表法将98例患者均分为研究组与对照组。研究组行纤维胆道镜联合腹腔镜治疗,对照组行常规腹腔镜手术治疗。比较两组的手术成功率、1年内的复发率、术中与术后情况(手术时间、术中失血量、住院时间)、术前与术后血清炎症因子指标[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、IL-6]与RAS活性指标[血管紧张素1-7(Ang1-7)、血管紧张素Ⅰ(AngⅠ)、血管紧张素Ⅱ(AngⅡ)],以及术后并发症情况。结果:研究组手术成功率高于对照组(97.96%vs83.67%;P<0.05),1年内复发率低于对照组(4.08%vs18.37%;P<0.05)。两组手术时间差异无统计学意义(P>0.05);研究组术中失血量、住院时间均低于对照组(P<0.01)。术后研究组TNF-α、IL-1β、IL-6水平低于对照组(P<0.01),Ang1-7、AngⅠ、AngⅡ水平低于对照组(P<0.01)。研究组术后并发症发生率低于对照组(2.04%vs16.33%,P<0.05)。结论:纤维胆道镜联合腹腔镜治疗肝外胆管结石效果显著,可以有效改善患者的炎症因子与RAS活性,具有创伤小、利于恢复、疗效可靠、安全性佳等优势,适于临床推广。

Objective:To investigate the effects of fiberoptic choledochoscopy combined with laparoscopy in the treatment of extrahepatic bile duct stones and its influences on inflammatory factors and renin-angiotensin system(RAS)activity.Methods:A multicenter,double-blind,randomized,double-simulated and parallel-controlled prospective study was conducted on 98 patients with extrahepatic bile duct stones who were admitted to our hospital from January 2018 to December 2019.They were randomly divided into two groups,including 49 cases in the study group and 49 cases in the control group.The study group was treated with fiberoptic choledochoscopy combined with laparoscopy,while the control group was treated with conventional laparoscopic surgery.The success rate of operation,recurrence rate within 1 year,intraoperative and postoperative conditions(operation time,blood loss during operation,length of stay),serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6)],RAS activity indicators[angiotensin 1-7(Ang1-7),angiotensinⅠ(AngⅠ),angiotensinⅡ(AngⅡ)]as well as postoperative complications were compared between the two groups.Results:The success rate of operation in the study group was higher than that in the control group(97.96%vs 83.67%,P<0.05),and the recurrence rate within 1 year was lower than that in the control group(4.08%vs 18.37%,P<0.05).There was no significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss and length of stay in the study group were lower than those in the control group(P<0.01).After operation,the levels of TNF-α,IL-1β,IL-6 in the study group were lower than those in the control group(P<0.01),and the levels of Ang1-7,AngⅠ,AngⅡin the study group were lower than those in the control group(P<0.01).The incidence of postoperative complications in the study group was lower than that in the control group(2.04%vs 16.33%,P<0.05).Conclusion:Fiberoptic choledochoscopy combined with laparoscopy is effective in the treatment of extrahepatic bile duct stones,which can effectively improve the inflammatory factors and RAS activity of patients,with less trauma,favorable recovery,reliable efficacy,and good safety.Therefore,it is suitable for clinical promotion.