双镜联合微创手术与开腹手术治疗复发性胆总管结石的临床效果对照研究

Comparative Study of Clinical Effect of Combined Double-scope Minimally Invasive Surgery and Open Surgery in the Treatment of Recurrent Choledocholithiasis

目的:探讨腹腔镜联合胆道镜微创手术治疗复发性胆总管结石患者的效果。方法:采用前瞻性随机研究方法,选取2020年7月—2022年12月松滋市人民医院收治的150例复发性胆总管结石患者作为研究对象,采用随机数字表法分为微创组与对照组,每组75例。微创组采用腹腔镜联合胆道镜微创手术治疗,对照组采用传统开腹手术治疗。对比分析两组围手术期指标,手术前后血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肿瘤坏死因子-α(TNF-α)、淀粉酶、外周血T淋巴细胞水平;对比两组手术前、术后1周的生存质量评分及并发症发生率。结果:微创组术中出血量、切口长度均小于对照组(P<0.05),微创组的术后下地活动时间、住院时间均短于对照组(P<0.05);微创组的手术时间长于对照组(P<0.05)。术前,两组血清ALT、AST、TNF-α、淀粉酶水平比较,差异均无统计学意义(P>0.05);术后24、72 h,微创组血清ALT、AST、TNF-α、淀粉酶水平均低于对照组,差异均有统计学意义(P<0.05)。术前,两组外周血CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平比较,差异均无统计学意义(P>0.05);术后24 h,微创组外周血CD3^(+)、CD4^(+)/CD8^(+)水平均高于对照组,CD8^(+)水平低于对照组,差异均有统计学意义(P<0.05)。术前,两组的SF-36各维度评分比较,差异无统计学意义(P>0.05);术后1周,微创组生理功能、躯体疼痛、总体健康、精神健康评分均高于对照组,差异均有统计学意义(P<0.05)。微创组并发症发生率为6.67%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论:较传统开腹手术,腹腔镜联合胆道镜微创手术治疗复发性胆总管结石患者具有创伤小,对患者肝功能、炎症反应、血清淀粉酶影响小,有利于患者术后早期生存质量的提高。

Objective:To investigate the effect of laparoscopic combined with choledochoscopy minimally invasive surgery in the treatment of patients with recurrent choledocholithiasis.Method:A prospective randomized study method was used to select 150 patients with recurrent choledocholithiasis treated in Songzi City People's Hospital from July 2020 to December 2022 as the study objects,and they were divided into minimally invasive group and control group by random number table method,with 75 cases in each group.The minimally invasive group was treated with laparoscopy combined with choledochoscope minimally invasive surgery,and the control group was treated with traditional open surgery.Perioperative indexes,serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),tumor necrosis factor-α(TNF-α),amylase and peripheral blood T lymphocyte levels before and after operation were compared between the two groups.The quality of life scores and the incidence of complications before and 1 week after operation were compared between the two groups.Result:The intraoperative blood loss and incision length in the minimally invasive group were lower than those in the control group(P<0.05),and the time of postoperative ground movement and hospital stay in the minimally invasive group were shorter than those in the control group(P<0.05).The operation time of minimally invasive group was longer than that of control group(P<0.05).Before surgery,there were no significant differences in serum ALT,AST,TNF-αand amylase levels between two groups(P>0.05);24 and 72 h after surgery,the levels of ALT,AST,TNF-αand amylase in minimally invasive group were lower than those in control group,the differences were statistically significant(P<0.05).Before surgery,there were no significant differences in the levels of peripheral blood CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)between two groups(P>0.05);24 h after surgery,the levels of CD3^(+),CD4^(+)/CD8^(+)in peripheral blood of the minimally invasive group were higher than those of the control group,and the levels of CD8^(+)were lower than those of the control group,the differences were statistically significant(P<0.05).Before surgery,there were no significant differences in SF-36 scores between the two groups(P>0.05);1 week after surgery,the scores of physiological function,physical pain,general health and mental health in the minimally invasive group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of complications in the minimally invasive group was 6.67%,lower than 20.00%in the control group,the difference was statistically significant(P<0.05).Conclusion:Compared with traditional open surgery,laparoscopic combined with choledochoscopy minimally invasive surgery in the treatment of patients with recurrent choledocholithiasis has less trauma,less influence on patients'liver function,inflammatory response,and serum amylase,and is conducive to improving patients'early postoperative quality of life.