比较腹腔镜手术与经内镜逆行性胰胆管造影术治疗胆总管结石临床疗效

Comparison of clinical efficacy of laparoscopic surgery and endoscopic retrograde cholangiopancreatography in the treatment of common bile duct stones

目的比较腹腔镜手术与经内镜逆行性胰胆管造影术治疗胆总管结石临床疗效。方法选择2020年1—12月本院收治的90例胆总管结石患者作为研究对象,按随机数表法分为腹腔镜组与内镜组两组,每组各45例。腹腔镜组予以腹腔镜手术,内镜组采用经内镜逆行性胰胆管造影术。比较两组手术治疗情况、术后并发症及结石复发率。比较两组术后不同时间疼痛及炎性因子水平。结果内镜组患者手术耗时、手术中出血量、住院费用及住院时间低于腹腔镜组,差异有统计学意义(P<0.05);内镜组患者术后1 d和术后3 d疼痛NRS评分均显著低于腹腔镜组,差异有统计学意义(P<0.05);术后7 d两组患者疼痛NRS评分比较,差异无统计学意义(P>0.05);内镜组患者术后并发症发生率(2.22%)显著少于腹腔镜组(13.33%),差异有统计学意义(P<0.05);术前和术后3 d,两组患者的血清C反应蛋白(CRP)和白介素-6(IL-6)水平比较,差异无统计学意义(P>0.05);术后1 d,腹腔镜组患者血清CRP和IL-6水平显著高于内镜组,差异有统计学意义(P<0.05);两组患者术后6个月结石复发率比较,差异无统计学意义(χ^(2)=1.011,P=0.315>0.05)。结论与腹腔镜手术相比,经内镜逆行性胰胆管造影术更有助于减轻术后创伤,减少术后并发症,降低炎性因子,缓解术后疼痛及促进术后恢复。

Objective To compare the clinical efficacy of laparoscopic surgery and endoscopic retrograde cholangiopancreatography in the treatment of common bile duct stones.Methods 90 cases of patients suffered with choledocholithiasis those were admitted to our hospital from January 2020 to December 2020 were randomly enrolled as study objects,and they were divided into laparoscopic group and endoscopic group according to random number method,45 cases in each group.The laparoscopic group was given laparoscopic surgery,and the endoscopic group was given endoscopic retrograde cholangiopancreatography.The surgical treatment,postoperative complications and stone recurrence rate were compared between the two groups.The pain of the two groups at different time after operation and the levels of inflammatory factors were compared.Results The operation time,intraoperative blood loss,hospitalization expenses and length of stay in endoscopic group were lower than those of the endoscopic group,the differences were statistically significant(P<0.05).The scores of numeric rating scales(NRS)of the study group were significantly lower than those of the laparoscopic group on the 1stdayand the 3rdday after operation(P<0.05).There was no significant difference in pain NRS scores between the two groups at 7 days after surgery(P>0.05).The incidence of postoperative complications in the endoscopic group(2.22%)was significantly lower than that in the laparoscopic group(13.33%),and the difference was statistically significant(P<0.05).There was no significant difference in serum C-reactive protein(CRP)and interleukin-6(IL-6)levels between 2 groups before surgery and 3 days after surgery(P<0.05).At one day after surgery,serum CRP and IL-6 levels in laparoscopic group were significantly higher than those in endoscopic group,with statistically significant differences(P<0.05).There was no significant difference in stone recurrence rate between the two groups at 6 month after surgery(χ^(2)=1.011,P=0.315).Conclusions Compared with laparoscopic surgery,endoscopic retrograde cholangiopancreatography is more helpful to reduce postoperative trauma,complications,inflammatory factors,pain and and improve recovery.