腹腔镜微创取石术后Ⅰ期缝合与T管引流对胆总管结石患者胃肠道功能恢复和肝功能及并发症的影响

Effect of primary suture and T-tube drainage on gastrointestinal function recovery,liver function and complications in patients with choledocholithiasis after laparoscopic minimally invasive lithotomy

目的探究腹腔镜微创取石术后Ⅰ期缝合与T管引流对胆总管结石患者胃肠道功能恢复及并发症的影响。方法选取2018年1月至2020年7月于本院行腹腔镜微创取石术的80例胆总管结石患者作为研究对象,按照术后处理方法不同分为缝合组(n=42)和引流组(n=38)。缝合组腹腔镜微创取石术后行Ⅰ期缝合治疗,引流组腹腔镜微创取石术后行T管引流治疗,比较两组手术指标、肠胃功能、肝功能、炎症反应及并发症发生情况。结果缝合组手术时间、肠鸣音恢复时间、肛门排气时间及住院时间均明显短于引流组,手术出血量少于对照组,差异有统计学意义(P<0.05)。两组谷丙转氨酶(ALT)、谷氨酰转肽酶(GGT)、谷草转氨酶(AST)、总胆红素(TBIL)水平组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:术后1、3 d后,两组ALT、GGT、AST、TBIL水平均明显高于术前,而术后3 d低于术后1 d,差异有统计学意义(P<0.05);组间比较:术后1、3 d,缝合组ALT、GGT、AST、TBIL水平均低于引流组,差异有统计学意义(P<0.05)。两组血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:术后1、3 d,两组血清TNF-α、CRP、IL-6水平均明显高于术前,而术后3 d低于术后1 d,差异有统计学意义(P<0.05);组间比较:术后1、3 d,缝合组血清TNF-α、CRP、IL-6水平均低于引流组,差异有统计学意义(P<0.05)。缝合组术后并发症发生率明显低于缝合组,差异有统计学意义(P<0.05)。结论与T管引流相比,腹腔镜微创取石术后行Ⅰ期缝合能明显缩短手术时间、住院时间,有助于促进肠胃功能快速恢复,且对肝功能损伤较小,还可减轻炎症反应,减少并发症的发生。

Objective To investigate the effect of primary suture and T-tube drainage on gastrointestinal function recovery and complications in patients with choledocholithiasis after laparoscopic minimally invasive lithotomy.Methods A total of 80 patients with choledocholithiasis who underwent laparoscopic minimally invasive lithotomy in our hospital from January 2018 to July 2020 were selected as the research subjects,and they were divided into the suture group(n=42)and the drainage group(n=38)according to different postoperative treatment methods.The suture group was treated with primary suture after laparoscopic minimally invasive lithotomy,and the drainage group was treated with T-tube drainage after laparoscopic minimally invasive lithotomy,the operative indexes,gastrointestinal function,liver function,inflammatory response and the incidence of complications were compared between the two groups.Results The operation time,recovery time of bowel sounds,anal exhaust time and hospitalization time in the suture group were significantly shorter than those in the drainage group,and the amount of operation bleeding was less than that in the drainage group,the differences were statistically significant(P<0.05).There were significant differences in the levels of alanine aminotransferase(ALT),γ-glutamyl transpeptidase(GGT),automatic spanning tree(AST)and total bilirubin(TBIL)between two groups of group,time points and interaction(P<0.05);comparison within the group:at 1 and 3 d after operation,the levels of ALT,GGT,AST and TBIL of the two groups were significantly higher than those before operation,but 3 d after operation were lower than 1 d after operation,the differences were statistically significant(P<0.05);comparison between groups:at 1 and 3 days after operation,the levels of ALT,GGT,AST and TBIL in the suture group were lower than those in the drainage group,the differences were statistically significant(P<0.05).There were significant differences in the levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)between two groups of group,time points and interaction(P<0.05).comparison within the group:at 1 and 3 d after operation,the serum levels of TNF-α,CRP and IL-6 of the two groups were significantly higher than before operation,but 3 d after operation were lower than 1 d after operation,the differences were statistically significant(P<0.05);comparison between groups:1 and 3 d after operation,the serum levels of TNF-α,CRP and IL-6 in the suture group were lower than those in the drainage group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the suture group was significantly lower than that in the drainage group,and the difference was statistically significant(P<0.05).Conclusion Compared with T-tube drainage,primary suture can significantly shorten operation time and the hospitalization time,which is beneficial to promote the rapid recovery of gastrointestinal function,and has less damage to liver function,and can also reduce the inflammatory response and the occurrence of complications.