腹腔镜与胆道镜钬激光碎石术联合治疗胆管结石的临床疗效观察

Clinical Observation of Laparoscopic and Choledochoscopic Holmium Laser Lithotripsy in the Treatment of Bile Duct Stones

目的:探讨胆管结石患者联合应用腹腔镜与胆道镜钬激光碎石术治疗的效果及对机体应激反应的影响。方法:选择120例胆管结石患者为研究对象,为我院2018年4月—2020年10月收治的。根据治疗方法不同进行分组,分为开腹组(n=60)和钬激光组(n=60),分别实施传统开腹手术、腹腔镜联合胆道镜钬激光碎石术,对两组术中及术后情况进行比较,比较两组结石取出率及术后并发症发生率;检测比较术前1天和术后3天的血清C-反应蛋白(CRP)、白细胞介素(IL-6)、肾上腺素(AD)、皮质醇(Cor)水平变化。结果:与开腹组比较,钬激光组手术时间、术中失血量、胃肠功能恢复时间、住院时间及术后并发症发生率均减少(P<0.05),结石取出率提高(P<0.05)。治疗后两组血清CRP、IL-6、Cor及AD水平升高(P<0.05),开腹组上述血清学指标水平高于钬激光组(P<0.05)。结论:与开腹手术相比,胆道结石患者联合应用腹腔镜与胆道镜钬激光碎石术治疗的效果满意,对患者创伤小、结石去除率高、术后并发症少、患者术后恢复快,对患者应激反应指标影响小,推广的临床价值较高。

Objective:To investigate the effect of laparoscopic and choledochoscopic holmium laser lithotripsy on patients with bile duct stones and its effect on stress response.Method:120 patients with bile duct stones were selected as the study subjects and were treated in our hospital from April 2018 to October 2020.According to different treatment methods,they were divided into laparotomy group(n=60)and holmium laser group(n=60).Traditional laparotomy and laparoscopy combined with choledochoscopic holmium laser lithotripsy were performed respectively.The intraoperative and postoperative conditions of the two groups were compared,and the stone removal rate and postoperative complication rate of the two groups were compared;The levels of serum C-reactive protein(CRP),interleukin(IL-6),adrenaline(AD)and cortisol(COR)were measured and compared 1 day before operation and 3 days after operation.Result:Compared with the laparotomy group,the operation time,intraoperative blood loss,gastrointestinal function recovery time,hospital stay and the incidence of postoperative complications in the holmium laser group were reduced(P<0.05),and the stone removal rate was increased(P<0.05).After treatment,the levels of serum CRP,IL-6,COR and AD in the two groups increased(P<0.05).The levels of the above serological indexes in the laparotomy group were higher than those in the holmium laser group(P<0.05).Conclusion:Compared with laparotomy,the effect of laparoscopic and choledochoscopic holmium laser lithotripsy in the treatment of biliary calculi is satisfactory.It has less trauma,high stone removal rate,less postoperative complications,rapid postoperative recovery,less impact on patients'stress response indicators,and has high clinical value.