LTSE及LCBDE对胆总管结石伴胆囊结石患者血清免疫球蛋白及炎症因子水平的影响

Effects of LTSE and LCBDE on Levels of Serum Immunoglobulins and Inflammatory Factors in the Treatment of Choledocholithiasis Complicated with Cholecystolithiasis

【目的】探讨腹腔镜下经胆囊管取石术(LTSE)及腹腔镜下胆总管切开取石术(LCBDE)对胆总管结石伴胆囊结石患者血清免疫球蛋白及炎症因子水平的影响。【方法】回顾性分析2019年1月至2022年1月本院收治的50例胆总管结石伴胆囊结石患者的临床资料,根据手术方法的不同将其分为观察组(行LTSE及LCBDE治疗)和对照组(开腹胆总管切开取石术联合胆囊切除术),每组25例。比较两组手术临床指标手术时间、切口长度、术中出血量、肠胃恢复时间、住院时间,比较两组手术前后血清免疫球蛋白G(IgG)、免疫球蛋白M(IgM)和免疫球蛋白A(IgA)水平及炎症因子[C反应蛋白(CRP)、白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]水平,统计两组术后并发症发生情况。【结果】观察组手术时间、切口长度、肠胃恢复时间、住院时间均短于对照组(P<0.05),术中出血量低于对照组(P<0.05)。观察组术后IgG、IgM、IgA水平与术前比较,差异无统计学意义(P>0.05);对照组术后IgG、IgM、IgA水平低于术前(P<0.05),观察组术后IgG、IgM、IgA水平高于对照组(P<0.05)。两组术后血清CRP、IL-6水平高于术前,IL-10、TNF-α水平低于术前,差异有统计学意义(P<0.05);观察组术后CRP、IL-6水平低于对照组(P<0.05),IL-10水平高于对照组(P<0.05),TNF-α水平与对照组比较,差异无统计学意义(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)。【结论】LTSE及LCBDE治疗胆总管结石伴胆囊结石临床安全性较好,对机体免疫功能影响较小,患者炎症反应较轻,值得临床借鉴。

【Objective】To observe the clinical effects of laparoscopic transcystic duct lithotripsy(LTSE)and laparoscopic common bile duct lithotomy(LCBDE)on the levels of serum immunoglobulin and inflammatory factors in the treatment of choledocholithiasis complicated with cholecystolithiasis.【Methods】Fifty patients with choledocholithiasis and cholecystolithiasis who admitted to our hospital from January 2015 to January 2019 were randomly divided into the observation group(LTSE and LCBDE)and the control group(open choledocholithotomy combined with cholecystectomy),with 25 cases in each group.The operation time,incision length,intraoperative bleeding volume,gastrointestinal recovery time and hospitalization time of the two groups were compared.The levels of serum immunoglobulin G(IgG),immunoglobulin M(IgM)and immunoglobulin A(IgA)before and after operation were analyzed.The levels of inflammatory factors C-reactive protein(CRP),interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factors in the two groups were observed.The level of tumor necrosis factor-alpha(TNF-α)was measured and the incidence of postoperative complications in the two groups was analyzed.【Results】The operation time,incision length,gastrointestinal recovery time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05),and the intraoperative bleeding volume was significantly lower than that of the control group(P<0.05).After operation,there were no significant differences in the levels of IgG,IgM and IgA between the observation group and the control group(P>0.05).The levels of IgG,IgM and IgA after operation in the observation group were significantly lower than those before operation(P<0.05),while the levels of IgG,IgM and IgA in the observation group were significantly higher than those in the control group(P<0.05).After operation,the levels of CRP and IL-6 in the two groups were significantly higher than those before operation(P<0.05),while the levels of IL-10 and TNF-αwere significantly lower than those before operation(P<0.05).There was no significant difference in the levels of TNF-αbetween the two groups after operation(P>0.05).However,the levels of CRP and IL-6 in the observation group were significantly lower than those in the control group,and the level of IL-10 was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group was 16.00%,which was significantly lower than 44.00%in the control group(P<0.05).【Conclusion】Compared with traditional operation,both LTSE and LCBDE have good clinical safety in the treatment of common bile duct stones and cholecystolithiasis,have little impact on the body's immune function,and have mild inflammatory reactions in patients.It is worthy of clinical reference..