LCBDE联合LC治疗结石性AOSC的疗效及对患者炎症因子和预后的影响

Efficacy of laparoscopic choledocholithotomy combined with laparoscopic cholecystectomy in the treatment of patients with calculous acute obstructive suppurative cholangitis and its influence on inflammatory factors and prognosis

目的探讨腹腔镜胆总管切开探查取石术(LCBDE)联合腹腔镜胆囊切除术(LC)治疗结石性急性梗阻性化脓性胆管炎(AOSC)的疗效及对患者炎症因子水平的影响。方法回顾性分析2018年1月至2022年1月于西安宝石花长庆医院诊治的的80例结石性AOSC患者的临床资料,依据术式不同分为对照组和研究组各40例。对照组患者接受内镜下括约肌切开取石术(EST)+LC治疗,研究组患者接受LCBDE+LC治疗。比较两组患者术后7 d的临床疗效、术中出血量、手术时间、术后下床活动时间、残留结石直径及术前与术后3 d炎症因子[包括白细胞介素-6(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)]水平。结果研究组患者的治疗总有效率为95.00%,明显高于对照组的72.50%,差异有统计学意义(P<0.05);研究组患者的术中出血量、术后下床活动时间、残留结石直径分别为(46.26±13.19)mL、(1.02±0.05)d、(4.08±1.58)mm,明显少于或短于对照组的(94.96±27.16)mL、(1.47±0.26)d、(6.35±1.02)mm,差异均有统计学意义(P<0.05);研究组和对照组患者的手术时间分别为(129.07±30.87)min,(133.45±39.25)min,差异无统计学意义(P>0.05);术前,两组患者的IL-6、CRP、TNF-α水平比较差异均无统计学意义(P>0.05);术后3 d,研究组患者的IL-6、CRP、TNF-α水平分别为(17.87±4.01)pg/mL、(14.22±3.23)mg/L、(109.42±10.93)pg/mL,明显低于对照组的(28.46±5.73)pg/mL、(26.47±4.60)mg/L、(157.04±16.58)pg/mL,差异均有统计学意义(P<0.05);研究组患者术后并发症总发生率为5.00%,明显低于对照组的20.00%,差异有统计学意义(P<0.05)。结论LCBDE联合LC治疗结石性AOSC能显著改善患者的炎症因子水平,临床疗效显著,且安全性较高。

Objective To investigate the efficacy of laparoscopic choledocholithotomy(LCBDE)combined with laparoscopic cholecystectomy(LC)in the treatment of calculous acute obstructive suppurative cholangitis(AOSC)and its effect on the level of inflammatory factors and prognosis.Methods The clinical data of 80 patients with AOSC diagnosed and treated in Gem Flower Xi'an Changqing Staff Hospital from January 2018 to January 2022 were retrospectively analyzed.The patients were divided into a control group and a study group according to different surgical methods,with 40 patients in each group.The control group received endoscopic sphincterotomy(EST)+LC treatment,and the study group received LCBDE+LC treatment.The clinical efficacy at 7 days after operation,intraoperative blood loss,operation time,postoperative ambulation time,residual stone diameter,and inflammatory factor levels before and 3 days after surgery[including interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)]were compared between the two groups.Results The total effective rate in the study group was 95.00%,significantly higher than 72.50%in the control group(P<0.05).The intraoperative blood loss,postoperative ambulation time,and residual stone diameter in the study group were(46.26±13.19)mL,(1.02±0.05)d,and(4.08±1.58)mm,significantly less/shorter than(94.96±27.16)mL,(1.47±0.26)d,and(6.35±1.02)mm in the control group(P<0.05).The operation time was(129.07±30.87)min in the study group,which showed no statistically significant difference with(133.45±39.25)min in the control group(P>0.05).Before surgery,IL-6,CRP,TNF-αshowed no statistically significant difference between the two groups(P>0.05);at 3 d after operation,the levels of IL-6,CRP,and TNF-αin the study group were(17.87±4.01)pg/mL,(14.22±3.23)mg/L,and(109.42±10.93)pg/mL,significantly lower than(28.46±5.73)pg/mL,(26.47±4.60)mg/L,(157.04±16.58)pg/mL in the control group(P<0.05).The incidence of complications in the study group was 5.00%,significantly lower than 20.00%in the control group(P<0.05).Conclusion LCBDE combined with LC in the treatment of calculous AOSC can significantly improve the level of inflammatory factors in patients,with significant clinical efficacy and high safety.