腹腔镜胆总管切开取石术对胆囊结石合并胆总管结石患者应激反应和生活质量的影响

Effect of laparoscopic choledocholithotomy on stress response and quality of life in patients with cholecystolithiasis and choledocholithiasis

目的探讨腹腔镜胆总管切开取石术(LCBDE)对胆囊结石合并胆总管结石患者应激反应和生活质量的影响。方法选择我院于2019年1月—2022年1月胆囊结石合并胆总管结石患者82例,依据随机数字表法分为观察组41例与对照组41例。观察组患者采用LCBDE治疗,对照组患者采用开腹手术治疗。比较两组手术情况,术后并发症,术前和术后3 d应激反应指标变化,术前和术后6个月生活质量改善情况,及随访6个月复发情况。结果观察组出血量少于对照组,肛门排气时间快于对照组,引流管拔除快于对照组,住院时间短于对照组,差异均有统计学意义(t=12.068、11.093、8.430,P均<0.001),而两组手术时间差异无统计学意义(t=0.630,P=0.531)。观察组并发症(4.88%)少于对照组(21.95%),差异有统计学意义(χ^(2)=5.145,P=0.023)。观察组术后3 d IL-6和CRP水平低于对照组,差异均有统计学意义(t=7.936、5.992,P均<0.001)。观察组术后6个月生活质量各指标及总分高于对照组,差异有统计学意义(t=11.315、5.746、11.344、8.786、14.595,P均<0.001)。两组复发率差异无统计学意义(精确概率法P=0.474)。结论LCBDE治疗胆囊结石合并胆总管结石患者效果良好,可减轻应激反应,以及提高生活质量。

Objective To explore the effect of laparoscopic choledocholithotomy(LCBDE)on the patients with cholecystolithiasis and choledocholithiasis and its influence on stress response and quality of life.Methods Totally 82 patients with cholecystolithiasis combined with choledocholithiasis from January 2019 to January 2022 in our hospital were divided into an observation group(41 cases)and a control group(41 cases)according to the random number table method.The observation group were treated with LCBDE,and the patients in the control group were treated with laparotomy.The operation conditions,postoperative complications,changes in stress response indicators before and 3 days after operation,the improvement of quality of life before and 6 months after operation,and the recurrence of 6 months follow-up were compared between the two groups.Results The observation group had less bleeding than the control group,faster anal exhaust time,faster drainage tube removal,and shorter hospital stay compared to the control group,with statistically significant differences between the two groups(t=12.068,11.093,8.430,all P<0.001).However,the operation time had no significant difference(t=0.630,P=0.531).The incidence of complications in the observation group(4.88%)was less than that in the control group(21.95%),the difference was statistically significant(χ^(2)=5.145,P=0.023).The levels of IL-6 and CRP in the observation group were lower than those in the control group 3 days after surgery,and the differences were statistically significant(t=7.936,5.992,both P<0.001).The four individual and total scores of qualities of life in the observation group at 6 months after surgery were higher than those in the control group,with statistically significant differences(t=11.315,5.746,11.344,8.786,14.595,all P<0.001).There was no statistically significant difference in recurrence rates between the two groups(accurate probability method P=0.474).Conclusion LCBDE has a good effect in the treatment of cholecystolithiasis combined with choledocholithiasis,which can reduce the stress response and improve th quality of life.