腹腔镜胆总管切开取石术一期缝合在老年肝外胆管结石治疗中的效果及安全性评价

Efficacy and safety of primary closure following laparoscopic choledochotomy in treatment of extrahepatic biliary calculi in elderly patients

目的 探讨腹腔镜胆总管切开取石术一期缝合在老年肝外胆管结石治疗中的效果及安全性。方法 选取老年肝外胆管结石患者148例为研究对象。所有患者均行腹腔镜胆总管切开取石术,其中88例行一期缝合(一期缝合组),60例做常规T管引流(常规组)。比较2组的手术相关指标、炎症因子水平变化、术后胃肠功能恢复情况以及并发症发生率。结果 一期缝合组的手术时间、术后引流时间、住院时间以及首次排气时间和肠鸣音恢复时间短于常规组,差异有统计学意义(P<0.05)。2组术中出血量、治疗总有效率比较,差异无统计学意义(P>0.05)。与术前相比,2组术后的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和总胆红素(TBIL)水平均呈先升后降低的变化趋势,不同时点差异均有统计学意义(P<0.05)。一期缝合组术后1、2 d的血清CRP、TNF-α、IL-1β水平低于常规组,差异有统计学意义(P<0.05)。一期缝合组的术后并发症总发生率为3.41%,低于常规组的11.67%,差异有统计学意义(P<0.05)。2组术后3个月内的胆总管狭窄发生率比较,差异无统计学意义(P>0.05)。结论 腹腔镜胆总管切开取石术一期缝合在老年肝外胆管结石患者治疗中的应用效果较好,有助于缩短手术时间,减轻炎症反应,降低术后并发症发生率,且安全性较高。

Objective To investigate the efficacy and safety of primary suture after laparoscopic choledochotomy in the treatment of elderly patients with extrahepatic bile duct stones.Methods A total of 148 elderly patients with extrahepatic bile duct stones were enrolled in this study.All patients underwent laparoscopic choledochotomy,among whom 88 received primary suture(primary suture group) and 60 underwent routine T-tube drainage(routine group).Surgical-related indicators,changes in inflammatory factor levels,recovery of postoperative gastrointestinal function and incidence of complications were compared between the two groups.Results The operative time,postoperative drainage time,hospital stay,first exhaust time and bowel sound recovery time were significantly shorter in the primary suture group than in the routine group(P <0.05).No statistically significant differences were observed in intraoperative blood loss and overall treatment efficacy between the two groups(P> 0.05).Compared with preoperative levels,the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),alanine aminotransferase(ALT),aspartate aminotransferase(AST) and total bilirubin(TBIL) increased initially and then decreased in both groups after surgery,with statistically significant differences at different time points(P <0.05).The serum levels of CRP,TNF-α and IL-β in the primary suture group were significantly lower than those in the routine group at 1 and 2 days after operation(P <0.05).The total incidence of postoperative complications was 3.41% in the primary suture group,which was significantly lower than the11.67% in the routine group(P <0.05).No statistically significant difference was observed in the incidence of common bile duct stenosis within 3 months after surgery between the two groups(P>0.05).Conclusion Primary suture after LCBDE exhibits favorable efficacy in the treatment of elderly patients with extrahepatic bile duct stones,which contributes to shorten operative time,relieve inflammatory response,reduce incidence of postoperative complications,and high safety.