摘要
目的:观察急性胆源性胰腺炎伴胆囊结石患者接受腹腔镜联合胆道镜手术与常规开腹手术的效果差异。方法:选取2017年8月—2020年1月鹿邑县人民医院收治的60例急性胆源性胰腺炎伴胆囊结石患者作为研究对象,随机分为开腹组与双镜组,每组各30例,开腹组进行常规开腹手术治疗,双镜组则给予腹腔镜联合胆道镜手术治疗,记录患者术中失血量、手术时间、住院总时长等围术期指标并组间比较,测定术前及术后3 d患者胆红素(TBIL)、谷草转氨酶(ALT)、丙二醛(MDA)、皮质醇(Cor)、去甲肾上腺素(NE)、胃泌素、胃动素水平,统计术后切口感染、胆漏、胆道感染等并发症发生情况。结果:双镜组术中失血量更少,住院总时长、手术时间更短,差异有统计学意义(t=11.584、4.672、4.311,P<0.05);术前两组患者ALT、TBIL、MDA、Cor、NE、胃泌素、胃动素水平趋于一致,差异无统计学意义(t=0.705、0.406、0.279、0.506、0.557、0.686、0.415,P>0.05),术后3 d ALT、TBIL、胃泌素、胃动素均见下降,MDA、Cor、NE均见上升,差异有统计学意义(t=14.775、8.465、3.425、5.941、5.406、7.102、7.092,P<0.05),双镜组ALT、TBIL、MDA、Cor、NE水平均低于开腹组,胃泌素、胃动素水平显著高于对照组,双镜组并发症发生率较开腹组更低,差异有统计学意义(χ^(2)=6.900、1.174、1.174、7.688,P<0.05)。结论:急性胆源性胰腺炎伴胆囊结石患者予以胆道镜联合腹腔镜手术可减轻手术创伤及手术应激,减轻对患者胃肠功能的影响,加速患者肝功能恢复,且术后并发症少于常规开腹手术。
Objective:To observe the difference in the effect of laparoscopic combined choledochoscopy and conventional lapa⁃rotomy in patients with acute biliary pancreatitis and cholecystolithiasis.Methods:A total of 60 patients with acute biliary pan⁃creatitis and cholecystolithiasis who were admitted to the hospital from August 2017 to January 2020 were selected and randomly divided into an laparotomy group and a double-endoscopy group,with 30 cases in each group.The laparotomy group received con⁃ventional laparotomy.The double-endoscopy group was given laparoscopic combined with choledochoscopy.The intraoperative blood loss,operation time,total length of hospital stay and other perioperative indicators were recorded and compared between groups.The levels of bilirubin(TBIL),aspartate aminotransferase(ALT),malondialdehyde(MDA),cortisol(Cor),norepinephrine(NE),gastrin and motilin in patients before and 3 d after surgery was determined.Postoperative incision infection,bile leakage,bili⁃ary tract infection and other complications were counted.Results:The double-endoscopy group had less intraoperative blood loss,shorter total hospital stay and shorter operation time,and the differences were statistically significant(t=11.584,4.672,4.311,P<0.05).The levels of ALT,TBIL,MDA,Cor,NE,gastrin and motilin in the two groups before surgery tended to be consistent,and the differences were not statistically significant(t=0.705,0.406,0.279,0.506,0.557,0.686,0.415,P>0.05).3 d after operation,ALT,TBIL,gastrin,and motilin all decreased,while MDA,Cor,and NE all increased,and the differences were statistically signifi⁃cant(t=14.775,8.465,3.425,5.941,5.406,7.102,7.092,P<0.05).The levels of ALT,TBIL,MDA,Cor,and NE in the double-en⁃doscopy group were lower than those in the laparotomy group,and the levels of gastrin and motilin were significantly higher than those in the control group.The incidence of complications in the double-endoscopy group was lower than that in the laparotomy group,and the differences were statistically signific
作者
王洽印
WANG Qia-yin(Luyi County People’s Hospital,Zhoukou,Henan,477200,China)
出处
《黑龙江医学》
2022年第14期1684-1686,共3页
Heilongjiang Medical Journal
基金
2019年度河南省科技攻关计划项目(LHGJ20190302)。
关键词
急性胆源性胰腺炎伴胆囊结石
胆道镜
腹腔镜
开腹手术
Acute biliary pancreatitis with cholecystolithiasis
Choledochoscopy
Laparoscopy
Open surgery
