腹腔镜、胆道镜联合钬激光治疗胆总管下端嵌顿性结石效果分析

Effect of Laparoscopy, Choledochoscopy Combined with Holmium Laser in the Treatment of Incarcerated Stones at the Lower End of Common Bile Duct

目的 探析胆总管下端嵌顿性结石患者采用腹腔镜、胆道镜联合钬激光治疗的效果。方法 随机选取2022年1月—2023年8月河池市中医医院收治的50例胆总管下端嵌顿性结石患者为研究对象,依据随机数表法分两组,各25例。对照组采用腹腔镜、胆道镜治疗,观察组联合钬激光治疗。比较两组结石清除率、血清胆汁生化指标水平及并发症发生率。结果 观察组结石清除率为96.00%高于对照组的76.00%,差异有统计学意义(χ^(2)=5.273,P=0.012)。治疗前,两组应激指标水平、血清胆汁生化指标水平比较,差异无统计学意义(P>0.05);治疗后,观察组促肾上腺皮质激素、去甲肾上腺素、肾上腺素水平均低于对照组,且血清胆汁生化指标水平包括总胆红素、结合胆红素、总胆汁酸、非结合胆红素也低于对照组,差异有统计学意义(P均<0.05)。观察组并发症发生率8.00%低于对照组的20.00%,差异有统计学意义(P<0.05)。结论 腹腔镜、胆道镜联合钬激光治疗胆总管下端嵌顿性结石的临床效果非常显著,其结石清除率明显提升,患者血清胆汁生化指标水平得到改善,防止并发症发生。

Objective To explore the effect of laparoscopy,choledochoscope combined with holmium laser in the treatment of patients with incarcerated stones at the lower end of common bile duct.Methods From January 2022 to August 2023,50 patients with incarcerated stones in the lower end of common bile duct admitted to Hechi Hospital of Traditional Chinese Medicine were randomly selected as the research objects.According to the random number table method,they were divided into two groups,25 cases in each group.The control group was treated with laparoscopy and choledochoscopy,and the observation group was treated with holmium laser.The stone clearance rate,serum bile biochemical index level and complication rate were compared between the two groups.Results The stone clearance rate in the observation group was 96.00%higher than that in the control group 76.00%,and the difference was statistically significant(χ^(2)=5.273,P=0.012).Before treatment,there was no statistically significant difference in stress index levels and serum bile biochemical index levels between the two groups(P>0.05);after treatment,the levels of adrenocorticotropic hormone,norepinephrine,and adrenaline in the observation group were lower than those in the control group,and the serum bile biochemical indicators,including total bilirubin,conjugated bilirubin,total bile acid,and unconjugated bilirubin,were also lower than the control group,and the differences were statistically significant(all P<0.05).The incidence of complications in the observation group was 8.00%lower than that in the control group,which was 20.00%,the difference was statistically significant(P<0.05).Conclusion The clinical effect of laparoscopy,choledochoscopy combined with holmium laser in the treatment of incarcerated stones at the lower end of the common bile duct is very significant,the stone clearance rate is significantly increased,the level of serum bile biochemical indexes of patients is improved,and complications are prevented.