摘要
目的比较腹腔镜胆总管切开取石术与十二指肠镜下胆总管取石术治疗胆总管结石效果和对患者术后胃肠功能影响。方法回顾性分析深圳市人民医院于2015年3月至2017年6月期间收治的158例胆总管结石患者的临床资料。按照手术方案分为腹腔镜组(79例)和十二指肠镜组(79例),腹腔镜组实施腹腔镜胆总管切开取石术治疗,十二指肠镜组患者实施十二指肠镜下胆总管取石术治疗。比较两组手术时间、术中出血量等围手术期指标,肠鸣音恢复时间、首次排气时间等肠胃功能指标以及手术前后PCT、CRP、IL-2等炎性因子水平。结果十二指肠镜组较腹腔镜组术中出血量少[(75.7±24.9)mL vs(109.8±13.6)mL]、下床早[(1.9±0.8)d vs(1.5±0.5)d]、住院时间短[(9.8±1.8)d vs(7.2±1.1)d],差异均具有统计学意义(P<0.05)。十二指肠镜组肠鸣音恢复时间[(25.5±9.4)h vs(58.8±16.3)h]、首次排气时间[(22.1±7.6)h vs(34.3±13.2)h]均较腹腔镜组早,组间有统计学差异(P<0.05)。术后两组PCT等炎性因子水平较术前均升高;两组术前差异无统计学意义,术后十二指肠镜组低于腹腔镜组,组间有统计学差异(P<0.05)。结论相比传统的腹腔镜胆总管切开取石术,十二指肠镜下胆总管取石术对患者术后胃肠功能影响较小、恢复较快、创伤小,并可达到相同的治疗效果。
Objective To compare efficacy and effect on postoperative gastrointestinal function between laparoscopic choledocholithotomy and duodenoscopic choledocholithotomy in patients with choledocholithiasis.Methods 158 patients with choledocholithiasis in Shenzhen People’s Hospital from Mar.2015 to Jun.2017 were retrospectively analyzed.According to different surgical schemes,patients were grouped as laparoscopic group(79 cases)and duodenoscopy group(79 cases).The laparoscopic group was treated with laparoscopic choledocholithotomy,and the duodenoscopy group was treated with duodenoscopic choledocholithotomy.The perioperative indexes such as operation time,intraoperative blood loss,out of bed time,hospitalization time,recovery time of bowel sounds,first exhaust time and other gastrointestinal functions were compared.The levels of PCT CRP IL-2 and other inflammatory factors of the two groups before and after operation were compared.Results The perioperative indexes of duodenoscopy group performed better than that of laparoscopic operation group in intraoperative blood loss[(75.70±24.89)mL vs(109.75±13.59)mL],hospitalization time[(9.81±1.85)d vs(7.19±1.13)d]and ambulation time[(1.91±0.77)d vs(1.53±0.53)d].The recovery time of bowel sounds[(25.5±9.4)min vs(58.8±16.3)min]and the first exhaust time[(22.1±7.6)h vs(34.3±13.2)h]of duodenoscopy group were shorter than that of laparoscopic operation group,with statistical difference(P<0.05).The PCT levels of the two groups were higher than that of preoperation,and which were lower in duodenoscopy group than that of laparoscopic operation group,with statistical difference(P<0.05).Conclusion Compared with the laparoscopic choledocholithotomy,duodenoscopic choledocholithotomy has less impact on postoperative gastrointestinal function,faster recovery and less trauma,and can achieve the same therapeutic affect.
作者
刘树旺
张丽芬
余小舫
LIU Shu-wang;ZHANG Li-fen;YU Xiao-fang(Department of Hepatobiliary and Pancreatic surgery,Shenzhen People’s Hospital,Shenzhen 518020,China)
出处
《肝胆胰外科杂志》
CAS
2021年第12期725-728,共4页
Journal of Hepatopancreatobiliary Surgery
关键词
胆总管结石
腹腔镜胆总管切开取石术
十二指肠镜下胆总管取石术
围手术期
胃肠功能
炎性因子
choledocholithiasis
laparoscopic choledocholithotomy
duodenoscopic choledocholithotomy
perioperative period
gastrointestinal function
inflammatory factors
