两种微创术式对胆囊结石合并胆总管结石患者术后肝功能及疼痛程度的影响

Effects of two minimally invasive surgical methods on postoperative liver function and pain in patients with cholecystolithiasis combined with common bile duct stones

目的 探究两种微创术式对胆囊结石合并胆总管结石患者术后肝功能及疼痛程度的影响。方法 使用随机数字表法将2019年1月至2022年6月在本院就诊的80例胆囊结石合并胆总管结石患者分为A组(40例)和B组(40例)。两组行腹腔镜胆总管探查术(LCBDE),A组行一期缝合,B组行T管引流。比较两组手术指标、手术前后肝功能指标、疼痛程度以及术后并发症发生情况。结果 两组患者术中出血量、取净率比较无明显差异(P>0.05);与B组患者相比,A组患者手术时间、术后肛门排气、术后住院时间明显较低(P<0.05);与术前相比,术后两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)水平明显降低(P<0.05),且A组较B组明显(P<0.05);术后1d、3d时,两组患者数字疼痛分级法(NRS)评分明显降低(P<0.05),且A组较B组明显(P<0.05);两组总并发症发生率比较无明显差异(P>0.05)。结论 与T管引流相比,胆囊结石合并胆总管结石患者LCBDE术后采用一期缝合效果更佳,可有效改善手术效果,促进肝功能恢复,降低疼痛程度,且对术后并发症无明显影响。

Objective To investigate effects of two minimally invasive surgical methods on postoperative liver function and pain in patients with cholecystolithiasis combined with common bile duct stones.Methods 80 patient with cholecystolithiasis and common bile duct stones who attended to our hospital from January 2019 to June 2022 were selected as research objects,and they were divided into the group A and group B by random number table method,with 40 cases in each group.Both groups were given laparoscopic common bile duct exploration(LCBDE),and the group A was given primary suture,and the group B was given T-tube drainage.The operation indexes,liver function indexes pain degree and postoperative complications were compared between the two groups before and after operation.Results There was no significant difference in intraoperative blood loss and net extraction rate between the two groups(P>0.05).The operation time,postoperative anal exhaust and postoperative hospital stay in the group A were significantly lower than those in the group B(P<0.05).After operation,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)in the two groups were significantly lower than those before operation(P<0.05),and those in the group A were significantly lower than those in the group B(P<0.05).At 1 day and 3 days after operation,the numeric eating scales(NRS)scores of the two groups were significantly decreased(P<0.05),and the group A was lower than the group B(P<0.05).There was no significant difference in the total complication rate between the two groups(P>0.05).Conclusion Compared with T-tube drainage,primary suture is more effective in patients with cholecystolithiasis combined with common bile duct stones,which can effectively improve the operation effect,promote the recovery of liver function,reduce the degree of pain,and has no significant effect on postoperative complications.