腹腔镜联合胆道镜取石术治疗肝胆管结石的临床效果

Clinical Effect of Laparoscopic Combined Choledochoscopic Lithotripsy in the Treatment of Hepatobiliary Duct Stones

目的探讨肝胆管结石患者采用腹腔镜联合胆道镜取石术治疗的临床效果。方法随机选取2020年1月—2022年12月龙岩市第二医院收治的40例肝胆管结石患者,按照随机数表法分为对照组(n=20)和观察组(n=20),对照组采用传统开腹取石术,观察组采用腹腔镜联合胆道镜取石术,对比两组患者围术期指标、治疗前后的免疫功能及并发症发生率。结果观察组的术中出血量少于对照组,差异有统计学意义(P<0.05);观察组的手术时间为(132.11±25.23)min,术后排气时间为(2.28±1.01)h,肠道功能恢复时间为(12.34±4.12)h,术后住院时间为(7.31±2.52)d,均短于对照组的(150.37±20.24)min,(3.52±1.46)h,(20.28±8.41)h,(9.55±2.48)d,差异有统计学意义(t=2.525、3.124、3.792、2.833,P<0.05);观察组治疗后的CD4^(+)、CD4^(+)/CD8^(+)均高于对照组,且CD8^(+)低于对照组,差异有统计学意义(P<0.05);观察组的并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜联合胆道镜取石术在肝胆管结石中的治疗效果较显著,不仅能有效减少患者的术中出血量,促进其术后康复,还能调节其免疫功能,减少并发症的发生。

Objective To explore the clinical effect of laparoscopic combined choledochoscopic lithotripsy in patients with hepatobiliary duct stones.Methods 40 patients with hepatobiliary admitted to Longyan Second Hospital from January 2020 to December 2022 were randomly selected and divided into control group(n=20)and observation group(n=20)according to random number table method.The control group received traditional open lithotripsy,and the observation group received laparoscopic combined choledochoscopic lithotripsy.Perioperative indexes,immune function before and after treatment,and complication rates of the two groups were compared.Results The intraoperative bleeding in the observation group was less than that in the control group,and the difference was statistically significant(P<0.05).The operation time was(132.11±25.23)min,the postoperative exhaust time was(2.28±1.01)h,the intestinal function recovery time was(12.34±4.12)h,and the postoperative hospitalization time was(7.31±2.52)d of the observation group,all of which were shorter than(150.37±20.24)min,(3.52±1.46)h,(20.28±8.41)h,(9.55±2.48)d of the control group,the difference was statistically significant(t=2.525,3.124,3.792,2.833,P<0.05).After treatment,CD4^(+)and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group,and CD8^(+)was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group was lower than that of the control group,the difference was statistically significant(P<0.05).Conclusion Laparoscopic combined with choledochoscopic lithotripsy has a more significant therapeutic effect in hepatobiliary duct stones,which not only effectively reduces the intraoperative bleeding of patients and promotes their postoperative recovery,but also regulates their immune function and reduces the occurrence of complications.