腹腔镜联合胆道镜胆总管探查术治疗胆总管结石对患者生化指标的影响分析

Analysis of the effect of laparoscopy combined with choledochoscope for common bile duct exploration in the treatment of common bile duct stones on the biochemical indicators of patients

目的分析腹腔镜联合胆道镜胆总管探查术治疗胆总管结石对患者生化指标的影响。方法选取于该院行开腹手术治疗的39例胆总管结石患者作为对照组;另选于该院行腹腔镜联合胆道镜胆总管探查术治疗的39例胆总管结石患者作为观察组。比较两组围术期指标、生化指标、并发症和预后情况。结果所有患者均已顺利完成手术,观察组术中无中转开腹者。观察组的手术用时比对照组长,而术中失血量比对照组低,且切口长度、禁食时间、首次下床时间、首次排气时间均比对照组短,差异均有统计学意义(P<0.05)。观察组术后7 d的血清丙氨酸氨基转移酶(ALT)、血清碱性磷酸酶(ALP)、天门冬氨酸氨基转移酶(AST)水平、总胆红素(TBIL)、间接胆红素(IBIL)及总胆汁酸(TBA)水平均比对照组低(P<0.05)。观察组ALT、ALP、AST、TBIL、IBIL及TBA恢复正常的时间均比对照组短(P<0.05)。观察组并发症发生率是15.38%,低于对照组的38.46%(P<0.05)。随访过程中,观察组的结石复发率为2.56%,低于对照组的17.95%(P<0.05)。结论腹腔镜联合胆道镜胆总管探查术治疗胆总管结石的疗效显著,有助于改善围术期指标,提高手术治疗的安全性,促进肝功能等相关生化指标及预后情况的改善。

Objective To analyze the effect of laparoscopy combined with choledochoscope for common bile duct exploration in the treatment of common bile duct stones on the biochemical indicators of patients.Methods A total of 39 patients with choledocholithiasis who underwent laparotomy in our hospital were enrolled as the control group,and 39 patients with choledocholithiasis who underwent laparoscopy combined with choledochoscope for common bile duct exploration were enrolled as the observation group.The perioperative indicators,biochemical indicators,complications and prognosis were compared between the two groups.Results All of these patients have successfully completed the operation.The observation group did not switch to laparotomy during the operation.In the observation group,the operation time was longer than the control group,while the blood loss during the operation was less than the control group,and the length of incision,fasting time,time to first get out of bed,and time to first exhaust were shorter than those in the control group,and the differences were statistically significant(P<0.05).The levels of serum alanine aminotransferase(ALT),alkaline phosphatase(ALP),aspartate aminotransferase(AST),total bilirubin(TBIL),indirect bilirubin(IBIL)and total bile acid(TBA)in observation group 7 days after operation were lower than those in the control group(P<0.05).The recovery times of ALT,ALP,AST,TBIL,IBIL and TBA in the observation group was shorter than those in the control group(P<0.05).The incidence of complications in the observation group was 15.38%,which was lower than that in the control group,which was 38.46%(P<0.05).During the follow-up,the recurrence rate of stones in the observation group was 2.56%,which was lower than that in the control group,which was 17.95%(P<0.05).Conclusion Laparoscopy combined with choledochoscope for common bile duct exploration has significant effect on the treatment of common bile duct stones,which can help to improve perioperative indicators,safety,as well as liver function,biochemical indicators and prognosis.