| 曾伟,李建明,周雪涛,陈晨,冯伟静.腹腔镜联合胆道镜手术清除胆总管结石的效果及患者的应激反应[J].中国临床保健杂志,2023,26(2):202-205. |
| 腹腔镜联合胆道镜手术清除胆总管结石的效果及患者的应激反应 |
| Effect of laparoscopy combined with choledochoscopy in the treatment of common bile duct stones and its effect on stress response |
| 投稿时间：2023-03-20 |
| DOI：10.3969/J.issn.1672-6790.2023.02.014 |
| 中文关键词: 胆总管结石病 腹腔镜检查 内窥镜检查,消化系统 应激,生理学 手术后并发症 |
| 英文关键词: Choledocholithiasis Laparoscopy Endoscopy,digestive system Stress,physiological Postoperative complications 〖FL |
| 基金项目:北京市西城区优秀人才培养资助骨干个人项目(2018-XCRC) |
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| 中文摘要: |
| 目的 探讨胆总管结石采用腹腔镜联合胆道镜手术治疗的结石清除效果以及对患者应激反应的影响。方法 选取2020年1月至2021年12月到北京市第二医院就诊的120例胆总管结石患者为研究对象,按照随机数字表法分为观察组60例和对照组60例,给予观察组患者腹腔镜联合胆道镜手术治疗,给予对照组患者内镜逆行性胰胆管造影术(ERCP)联合乳头括约肌切开术(EST)治疗,对比2组疗效。结果 观察组结石清除率为96.67%(58/60),对照组结石清除率为78.33%(47/60),观察组显著较高(χ2=9.219,P=0.002)；2组术中出血量、引流管拔管时间比较,差异无统计学意义(P＞0.05),观察组手术时间、胃肠道功能恢复时间及住院时间显著低于对照组(P＜0.05)；术后C反应蛋白(CRP)、白细胞介素(IL)-6、肾上腺素(EP)、皮质醇(CO)水平显著升高,自然杀伤细胞(NK)水平显著下降,观察组变化幅度显著小于对照组(P＜0.05)；2组并发症发生率比较,差异无统计学意义(P＞0.05),随访1年观察组复发率和再手术率显著低于对照组(P＜0.05)。结论 腹腔镜联合胆道镜手术治疗胆总管结石能够缩短术后胃肠功能恢复时间与住院时间,提高结石清除率,减少应激反应,降低复发率与再手术率。 |
| 英文摘要: |
| Objective To investigate the stone removal effect of laparoscopic combined with choledochoscopy in the clinical treatment of common bile duct stones and its impact on the stress response of patients.Methods One hundred and twenty patients with choledocholithiasis who came to Beijing Second Hospital from January 2020 to December 2021 were selected as the research objects.They were randomly divided into 60 cases in the observation group and 60 cases in the control group.The patients in the observation group were treated with laparoscopy combined with choledochoscopy,and the patients in the control group were treated with endoscopic retrograde cholangiopancreatography (ERCP) combined with sphincterotomy (EST).The curative effects of the two groups were compared.Results The stone clearance rate was 96.67% (58/60) in the observation group and 78.33% (47/60) in the control group,which was significantly higher in the observation group (χ2=9.219,P=0.002);There was no significant difference in intraoperative bleeding and drainage tube extubation time between the two groups (P>0.05).The operation time,gastrointestinal function recovery time and hospitalization time in the observation group were significantly lower than those in the control group (P<0.05);After operation,the levels of C-reactive protein (CRP),interleukin (IL)-6,epinephrine (EP) and cortisol (CO) increased significantly,and the level of natural killer cells (NK) decreased significantly.The change range of the observation group was significantly smaller than that of the control group (P<0.05);There was no significant difference in the incidence of complications between the two groups (P>0.05).The recurrence rate and reoperation rate of the observation group were significantly lower than those of the control group (P<0.05).Conclusions Laparoscopy combined with choledochoscopy in the treatment of common bile duct stones can shorten the recovery time of gastrointestinal function and hospital stay,improve the stone clearance rate,reduce stress response,and reduce the recurrence rate and reoperation rate. |
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