一步法腹腔镜手术治疗胆囊结石合并胆总管结石的疗效分析

Efficacy Analysis of One-Step Laparoscopic Surgery in Treatment of Cholecystolithiasis with Choledocholithiasis

目的:分析一步法腹腔镜手术在胆囊结石合并胆总管结石患者中的疗效及对炎性因子的影响。方法:选取2019年1月—2021年12月张家港市第一人民医院收治的249例胆囊结石合并胆总管结石患者为研究对象,按手术方式的不同分为对照组与观察组。对照组接受分步法手术,观察组接受一步法腹腔镜手术。比较两组治疗效果、术后置管情况、手术指标、术后并发症发生情况及C反应蛋白(CRP)、白细胞(WBC)、中性粒细胞计数(NEUT)水平。结果:观察组治愈率高于对照组,差异有统计学意义(P<0.05)。观察组术后置管例数多于对照组,差异有统计学意义(P<0.05)。两组术后排气时间、术中出血量比较,差异无统计学意义(P>0.05);观察组住院费用少于对照组,住院时间短于对照组,手术时间长于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。两组各时间点WBC水平比较,差异无统计学意义(P>0.05);手术当日、术后1 d,两组NEUT、CRP水平高于入院时,以术后1 d最高,且观察组低于对照组,差异有统计学意义(P<0.05);术后5 d,观察组NEUT、CRP水平低于入院时,差异有统计学意义(P<0.05)。结论:针对胆囊结石合并胆总管结石患者,实施一步法腹腔镜手术治疗,能够快速缓解患者痛苦,疗效好。

Objective:To analyze the efficacy of one-step laparoscopic surgery in patients with cholecystolithiasis complicated with choledocholithiasis and its influence on inflammatory factors.Methods:From January 2019 to December 2021,249 patients with cholecystolithiasis complicated with choledocholithiasis admitted to Zhangjiagang First People's Hospital were selected as the study subjects.The patients were divided into the control group and the observation group according to the different surgical approaches.The control group received stepwise surgery,while the observation group received one-step laparoscopic surgery.The treatment effect,postoperative catheterization,surgical indexes,postoperative complications,C-reactive protein(CRP),white blood cells(WBC),and neutrophil count(NEUT)levels were compared between the two groups.Results:The healing rate in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).The number of cases with postoperative catheterization in observation group was high than that in control group,and the difference was statistically significant(P<0.05).There were no significant differences in postoperative exhaust time and intraoperative blood loss between the two groups(P>0.05).The hospitalization cost in the observation group was less than that in the control group,the length of hospital stay in the observation group was shorter than that in the control group,and the operation time in the observation group was longer than that in the control group,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in WBC levels between the two groups at each time point(P>0.05).On the day of surgery and 1 d after surgery,the levels of NEUT and CRP in the two groups were higher than those at admission and peaked on 1 d after surgery,the observation group was higher than the control group,and the difference was statistically significant(P<0.05).On 5 d after surgery,the NEUT and CRP levels in the observation group were lower than those at admission,and the difference was statistically significant(P<0.05).Conclusion:For patients with cholecystolithiasis complicated with choledocholithiasis,one-step laparoscopic surgery can rapidly ameliorate the pains of patients and has good efficacy.