十二指肠镜、腹腔镜、胆道镜三镜联合手术治疗胆囊结石 合并胆总管巨大结石的临床效果

Clinical effect of duodenoscope,laparoscope and choledochoscope three-mirror combined operation in the treatment of cholecystolithiasis complicated with large common bile duct calculi

目的探究十二指肠镜、腹腔镜、胆道镜三镜联合手术治疗胆囊结石合并胆总管巨大结石的临床效果。方法选取2018年6月至2020年6月收治的102例胆囊结石合并胆总管巨大结石患者作为研究对象,根据数字随机法将其分为参照组与观察组,各51例。参照组给予腹腔镜联合胆道镜手术治疗,观察组给予十二指肠镜、腹腔镜、胆道镜三镜联合手术治疗。比较两组患者的临床效果。结果观察组的术后肛门排气时间、术后进食时间、术后引流时间、住院时间均短于参照组,差异具有统计学意义(P<0.05)。观察组的结石清除总有效率高于参照组,差异具有统计学意义(P<0.05)。术后1、3 d时,观察组的IL-6、CRP、ACTH、Cor水平均低于参照组,差异具有统计学意义(P<0.05)。术后3 d,观察组的IgA、IgM、IgG水平、CD3^(+)、CD4^(+)、CD8^(+)均高于参照组,差异具有统计学意义(P<0.05)。术后3 d,观察组的ALP、GGT水平均低于参照组,差异具有统计学意义(P<0.05)。术后3 d,观察组的NO、5-HT水平低于参照组,GAS、AChE水平高于参照组,差异具有统计学意义(P<0.05)。结论十二指肠镜、腹腔镜、胆道镜三镜联合手术治疗胆囊结石合并胆总管巨大结石患者的结石清除率显著,可改善患者的康复情况、术后应激水平、胃肠功能、免疫功能指标。

Objective To investigate the clinical effect of duodenoscope,laparoscope and choledochoscope three-mirror combined operation in the treatment of cholecystolithiasis complicated with large common bile duct calculi.Methods A total of 102 patients with cholecystolithiasis complicated with large common bile duct calculi treated from June 2018 to June 2020 were selected as the research objects,and the patients were divided into reference group and observation group according to the digital random method,with 51 cases in each group.The reference group was treated with laparoscope combined with choledochoscope,and the observation group was treated with duodenoscope,laparoscope and choledochoscope three-mirror combined operation.The clinical effects of the two groups were compared.Results The postoperative anal exhaust time,postoperative eating time,postoperative drainage time and hospital stay in the observation group were shorter than those in the reference group,and the differences were statistically significant(P<0.05).The total effective rate of stone removal in the observation group was higher than that in the reference group,and the differences was statistically significant(P<0.05).At 1 and 3 d after operation,the levels of IL-6,CRP,ACTH and Cor in the observation group were lower than those in the reference group,and the differences were statistically significant(P<0.05).At 3 d after operation,the IgA,IgM,IgG levels,CD3^(+),CD4^(+)and CD8^(+)in the observation group were higher than those in the reference group,and the differences were statistically significant(P<0.05).At 3 d after operation,the levels of ALP and GGT in the observation group were lower than those in the reference group,and the differences were statistically significant(P<0.05).At 3 d after operation,the levels of NO and 5-HT in the observation group were lower than those in the reference group,and the levels of GAS and AChE in the observation group were higher than those in the reference group,and the differences were statistically significant(P<0.05).Conclusion Duodenoscope,laparoscope and choledochoscope three-mirror combined operation in the treatment of patients with cholecystolithiasis complicated with large common bile duct calculi has significant stone removal rate,it can improve the rehabilitation,postoperative stress level,gastrointestinal function and immune function indexes.