腹腔镜联合胆道镜保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的临床效果比较

Comparison of clinical effects of laparoscope combined with choledochoscope gallbladder preserving lithotomy and laparoscopic cholecystectomy in the treatment of gallstones

目的 比较腹腔镜联合胆道镜保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的效果及其对胃肠激素水平、结石复发情况的影响。方法 选择2019年1月至2022年1月我院收治的90例胆囊结石患者作为研究对象,以随机数字表法将其分为对照组和观察组,各45例。对照组给予腹腔镜胆囊切除术治疗,观察组采用腹腔镜联合胆道镜保胆取石术治疗。比较两组的手术相关指标、胃肠激素水平、并发症及复发情况、胃泌素(GAS)、胃动素(MTL)、生长抑素(SS)水平、应激指标。结果 观察组的手术时间长于对照组,术中出血量少于对照组,术后下床活动时间短于对照组(P<0.05)。术后30 d,观察组的胆囊收缩素(CKK)、血管活性肠肽(VIP)及胃蛋白酶原Ⅰ(PGⅠ)水平高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05);两组的复发率比较,差异无统计学意义(P>0.05)。术后30 d,观察组的GAS、MTL、SS水平低于对照组(P<0.05)。术后30 d,观察组的C-反应蛋白(CRP)、肾上腺素(E)、皮质醇(Cor)水平低于对照组(P<0.05)。结论 腹腔镜结合胆道镜保胆取石术治疗胆囊结石的效果较好,不仅能有效改善患者的胆囊功能,也能提高胃肠激素水平,减少术后并发症,且复发率低,值得推广。

Objective To compare the effects of laparoscope combined with choledochoscope gallbladder preserving lithotomy and laparoscopic cholecystectomy in the treatment of gallstones and its influences on gastrointestinal hormone levels and stone recurrence. Methods A total of 90 patients with gallstones admitted in our hospital from January 2019 to January 2022 were selected as the research objects. The patients were divided into control group and observation group by random number table method, with 45 cases in each group. The control group was treated with laparoscopic cholecystectomy, and the observation group was treated with laparoscope combined with choledochoscope gallbladder preserving lithotomy. The operation related indexes, gastrointestinal hormone levels, complications and recurrence, gastrin(GAS), motilin(MTL), somatostatin(SS) levels and stress indexes were compared between the two groups. Results The operation time of the observation group was longer than that of the control group, the intraoperative blood loss was less than that of the control group, and the postoperative ambulation time was shorter than that of the control group(P<0.05). At 30 d after operation, the levels of cholecystokinin(CKK), vasoactive intestinal peptide(VIP) and pepsinogen Ⅰ(PG Ⅰ) in the observation group were higher than those in the control group(P <0.05). The total incidence of complications in the observation group was lower than that in the control group(P<0.05);there was no significant difference in the recurrence rate between the two groups(P>0.05). At 30 d after operation, the levels of GAS, MTL and SS in the observation group were lower than those in the control group(P <0.05). At 30 d after operation, the levels of C-reactive protein(CRP),epinephrine(E) and cortisol(Cor) in the observation group were lower than those in the control group(P<0.05). Conclusion Laparoscope combined with choledochoscope gallbladder preserving lithotomy has a good effect in the treatment of gallstones. It can not only effectively ameliorate the gallbladder function of patients, but also improve the level of gastrointestinal hormones, reduce postoperative complications, and the recurrence rate is low. It is worth promoting.