不同微创术式对胆总管结石患者炎症反应和免疫功能的影响

Effects of Different Minimally Invasive Procedures on Inflammatory Response and Immune Function in Patients with Common Bile Duct Stones

目的:探讨不同微创术式对胆总管结石患者炎症反应和免疫功能的影响。方法:选取2021年9月—2022年12月景德镇市第一人民医院收入的80例胆总管结石患者,按随机数字表法分为两组,各40例。Ⅰ组采取腹腔镜下胆总管探查术(LCBDE)治疗;Ⅱ组采取内镜下十二指肠乳头括约肌切开术(EST)治疗。对比两组围手术期指标[术中出血量、手术时间、住院时间]、炎症反应[C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、免疫功能[CD3~+、CD4~+、CD4~+/CD8~+]及并发症。结果:Ⅰ组住院时间短于Ⅱ组,差异有统计学意义(P<0.05)。术后,Ⅰ组CRP、IL-6、TNF-α均低于Ⅱ组,差异均有统计学意义(P<0.05)。术后,Ⅰ组CD3~+、CD4~+、CD4~+/CD8~+均高于Ⅱ组,差异均有统计学意义(P<0.05)。Ⅰ组并发症发生率(5.00%)低于Ⅱ组(20.00%),差异有统计学意义(P<0.05)。结论:LCBDE与EST均可有效治疗胆总管结石,但LCBDE具有改善患者术后炎症反应和免疫功能各项水平的特点,从而降低患者术后并发症的发生率。

Objective:To investigate the effects of different minimally invasive procedures on inflammatory response and immune function in patients with common bile duct stones.Method:A total of 80 patients with common bile duct stones from Jingdezhen NO.1 People's Hospital from September 2021 to December 2022 were selected and divided into two groups according to random number table method,with 40 cases each group.GroupⅠwas treated with laparoscopic common bile duct exploration(LCBDE).groupⅡwas treated with endoscopic sphincterotomy(EST).Perioperative indexes[intraoperative bleeding volume,operative time,length of hospital stay],inflammatory response[C reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],immune function[CD3+,CD4+,CD4+/CD8+]and complications were compared between the two groups.Result:The length of hospital stay in group I was shorter than that in groupⅡ,the difference was statistically significant(P<0.05).After operation,CRP,IL-6 and TNF-αof groupⅠwere lower than those of groupⅡ,the differences were statistically significant(P<0.05).After operation,CD3+,CD4+,CD4+/CD8+of groupⅠwere higher than those in groupⅡ,the differences were statistically significant(P<0.05).The incidence of complications in groupⅠ(5.00%)was lower than that in groupⅡ(20.00%),the difference was statistically significant(P<0.05).Conclusion:Both LCBDE and EST can effectively treat common bile duct stones,but LCBDE has the characteristics of improving of postoperative inflammatory response and levels of immune function of patients,so as to reduce the incidence of postoperative complications of patients.