双镜联合保胆取石术与腹腔镜胆囊切除术治疗胆囊结石患者疗效对比分析

Comparative analysis on the curative efficacy of laparoscopic-choledochoscopic cholelithotomy and laparoscopic cholecystectomy in patients with gallbladder stones

目的比较采取双镜联合保胆取石术与腹腔镜胆囊切除术治疗胆囊结石患者的疗效。方法2015年2月~2020年2月我院收治的78例胆囊结石患者,其中36例接受腹腔镜联合胆道镜保胆取石术,另42例接受腹腔镜胆囊切除术,术后随访12个月。采用ELISA法或双抗体夹心免疫发光法检测血清皮质醇(COR)和C反应蛋白(CRP)。结果观察组手术时间和住院费用分别为(53.3±17.7)min和(3.2±0.5)万元,显著长于或高于对照组【(36.7±10.8)min和(2.3±0.4)万元,P<0.05】,术后进食和肛门排气时间分别为(2.8±0.9)h和(14.9±3.2)h,均显著短于对照组【分别为(3.3±0.7)h和(19.3±4.1)h,P<0.05】;在术后3 d,观察组血清CRP和COR水平分别为(11.2±3.1)mg/L和(195.6±30.8)ng/mL,显著低于对照组【分别为(19.0±4.9)mg/L和(211.6±32.7)ng/mL,P<0.05】;术后2周行超声检查,发现观察组患者胆囊功能完好,无结石残留;随访3个月,观察组患者出现切口感染、腹泻、反流性胃炎、胆道出血和急性胰腺炎等并发症发生率为11.1%,显著低于对照组【31.0%,P<0.05】;在随访12个月末,观察组结石复发为2.8%。结论采取双镜联合保胆取石术治疗胆囊结石患者可能更有利于患者胃肠功能的恢复,减少术后并发症的发生,值得进一步探索。

Objective The aim of this study was to compare the curative efficacy of laparoscopic-choledochoscopic cholelithotomy and laparoscopic cholecystectomy(LC)in patients with gallbladder stones.Methods 78 patients with gallbladder stones were admitted to our hospital between February 2015 and February 2020,and out of them,36 patients underwent laparoscopic-choledochoscopic cholelithotomy and 42 patients underwent LC.They were followed up for 12 months after surgery.Serum cortisol and C-reactive protein(CRP)levels were detected by ELISA or double-antibody sandwich immunoluminescence assay.Results The operation time and hospitalization cost in observation group were(53.3±17.7)min and(3.2±0.5)ten thousand yuan,significantly longer or higher than[(36.7±10.8)min and(2.3±0.4)ten thousand yuan,P<0.05],and the postoperative eating time and anal exhaust time were(2.8±0.9)h and(14.9±3.2)h,significantly shorter than[(3.3±0.7)h and(19.3±4.1)h,respectively,P<0.05]in the control;3 days after surgery,serum CRP and COR levels in the observation group were(11.2±3.1)mg/L and(195.6±30.8)ng/mL,significantly lower than[(19.0±4.9)mg/L and(211.6±32.7)ng/mL,respectively,P<0.05]in the control;the ultrasonography 2 weeks after surgery showed that there were no residual stones in the observation group,and the gallbladder function was intact;at 3 months of follow-up,the incidence of complications,such as incision infection,abdominal distension and diarrhea,reflux gastritis,biliary hemorrhage and acute pancreatitis in the observation group was significantly lower than that in the control group(11.1%vs.31.0%,P<0.05);at the end of 12-month follow-up,one patient(2.8%)had stone recurrence.Conclusion The application of laparoscopic-choledochoscopic cholelithotomy in the treatment of patients with gallbladder stone might be more beneficial to the recovery of gastrointestinal functions with less postoperative complications.