摘要
目的探讨腹腔镜联合胆道镜治疗胆结石合并肝外胆管结石的效果及对免疫功能的影响。方法回顾性分析2018年8月至2020年8月长治市第三人民医院普外科收治的105例胆结石合并肝外胆管结石患者的临床资料,男55例,女50例,年龄(60.25±2.65)岁,年龄范围为53~72岁。按照不同手术方法分为传统组(n=58)与双镜组(n=47),传统组给予传统开腹结石切除术治疗,双镜组给予腹腔镜联合胆道镜结石切除术治疗,比较两组患者的围术期指标、术前与术后免疫功能指标及术后并发症发生率。结果双镜组患者术中出血量[(43.58±5.17)ml]、手术时间[(104.22±16.50)min]、术后排气时间[(26.44±8.21)h]、切口长度[(2.45±1.04)cm]、术后住院时间[(6.54±1.46)d]均少于传统组[(71.02±6.14)ml、(128.75±20.57)min、(35.10±6.58)h、(9.26±1.58)cm、(11.56±1.82)d],差异有统计学意义(P<0.05)。传统组患者术后1 d的表面抗原分化簇4(CD4^(+))为[(30.15±1.08)%]、表面抗原分化簇8(CD8^(+))为[(24.54±1.60)%]、免疫球蛋白G(IgG)为[(10.28±1.63)g/L]、免疫球蛋白A(IgA)为[(2 556.43±62.89)mg/L]、免疫球蛋白M(IgM)为[(1 510.56±114.35)mg/L]水平均低于术前1 d[(35.62±1.17)%、(25.75±1.32)%、(11.59±1.62)g/L、(2 762.58±60.85)mg/L、(1 574.25±121.58)mg/L],差异有统计学意义(P<0.05)。双镜组患者术后1 d的CD4^(+)[(30.24±1.17)%]、CD8^(+)[(24.47±1.57)%]、IgG[(10.35±1.59)g/L]、IgA[(2 571.02±60.55)mg/L]及IgM[(1 507.74±109.88)mg/L]水平均低于术前1 d[(35.68±1.09)%、(25.64±1.26)%、(11.63±1.54)g/L、(2 751.42±61.74)mg/L、(1 580.96±115.47)mg/L],差异有统计学意义(P<0.05)。两组患者术后1 d的CD4^(+)、CD8^(+)、IgG、IgA及IgM水平比较,差异无统计学意义(P>0.05)。双镜组患者术后并发症发生率与传统组比较,差异无统计学意义(P>0.05)。结论腹腔镜联合胆道镜治疗胆结石合并肝外胆管结石的围术期指标更好,不会对免疫功能指标造成较大的影响,术后未增加并发症发生率,安全性较高。
Objective To investigate the therapeutic effect of laparoscopy combined with choledochoscope in the treatment of cholelithiasis complicated with extrahepatic bile duct stones and its effect on immune function.Methods Clinical data of 105 patients with cholelithiasis complicated with extrahepatic bile duct stones who were admitted to the department of General Surgery of the Third People′s Hospital of Changzhi City,from August 2018 to August 2020 were retrospectively analyzed,including 55 males and 50 females,aged(60.25±2.65)years old,ranging from 53 to 72 years old.According to different surgical methods,patients were divided into the traditional group(n=58)and the dual-lens group(n=47).The traditional group of patients were treated with traditional open calculi resection,and the dual-lens group of patients were treated with laparoscopy combined with choledochoscope for calculi resection.The perioperative indexes,preoperative and postoperative immune function indexes and the incidence of postoperative complications were compared between the two groups.Results In the dual-lens group,intraoperative blood loss[(43.58±5.17)ml],operative time[(104.22±16.50)minutes],postoperative discharge time[(26.44±8.21)hours],incision length[(2.45±1.04)cm],postoperative hospitalization time[(6.54±1.46)days]were all lower than those in the traditional group[(71.02±6.14)ml,(128.75±20.57)minutes,(35.10±6.58)hours,(9.26±1.58)cm and(11.56±1.82)days],and the difference was statistically significant(P<0.05).The level of cluster of differentiation 4(CD4^(+))is[(30.15±1.08)%],cluster of differentiation 8(CD8^(+))is[(24.54±1.60)%],Immunoglobulin G(IgG)is[(10.28±1.63)g/L],Immunoglobulin A(IgA)is[(2556.43±62.89)mg/L]and Immunoglobulin M(IgM)is[(1510.56±114.35)mg/L],all lower than those of 1 day before surgery[(35.62±1.17)%,(25.75±1.32)%,(11.59±1.62)g/L,(2762.58±60.85)mg/L and(1574.25±121.58)mg/L],and the difference was statistically significant(P<0.05).The levels of CD4^(+)[(30.24±1.17)%],CD8^(+)[(24.47±1.57)%],IgG[(10.35±1.59)g/L],IgA[(2571.02±60.55)mg/L]and IgM[(1507.74±109.88)mg/L]on day 1 after surgery in dual-lens group were all lower than those 1 day before surgery[(35.68±1.09)%,(25.64±1.26)%,(11.63±1.54)g/L,(2751.42±61.74)mg/L and(1580.96±115.47)mg/L],P<0.05.There was no statistical significance in the levels of CD4^(+),CD8^(+),IgG,IgA and IgM in two groups 1 day after surgery(P>0.05).The incidence of postoperative complications in the dual-lens group was not statistically significant different from that in the traditional group(P>0.05).Conclusion The perioperative indexes of laparoscopy combined with choledochoscope in the treatment of gallstones with extrahepatic bile duct stones are better,postoperative complications do not increase and the incidence of postoperative complications is lower with higher safety.
作者
屈定杰
姬变玲
武江
Qu Dingjie;Ji Bianling;Wu Jiang(Department of General Surgery,Third People′s Hospital of Changzhi City,Changzhi 046021,China)
出处
《中国临床实用医学》
2021年第1期29-33,共5页
China Clinical Practical Medicine
关键词
腹腔镜
胆道镜
肝结石
肝外胆管结石
免疫功能
Laparoscopy
Choledochoscope
Hepatic calculi
Extrahepatic bile duct stones
The immune function
