两种术式对于胆道结石患者术后胆道压力与胃肠道功能研究
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摘要
目的探讨微创手术和开腹手术治疗胆道结石患者的临床疗效及对胆道压力和胃肠道功能的影响,分析胆道压力与胃肠功能的相互关系。方法回顾性分析2016年1月至2018年1月收治的124例胆道结石患者。开腹组60例患者采用开腹手术治疗,微创组64例患者采用腹腔镜下胆道镜内镜联合钬激光碎石术治疗。采用SPSS18. 00统计软件分析,术中术后指标、炎性因子检测、术后胆道压测定和胃肠动力指标检测,以均数(x珋±s)形式录入,采用独立t检验;净石率、术后并发症比较采用χ2检验;胆道压力与胃肠动力指标相关性分析采用Spearman相关分析,以P <0. 05表示差异有统计学意义。结果微创组手术时间、住院天数、住院费用、净石率、并发症率均优于开腹组(P <0. 05);微创组术后3 d、5 d血清IL-6、IL-8、TNF-α浓度、MTL、CCK、VIP水平和胆道压力和均显著低于开腹组(P <0. 05);患者术后胆道压力与胃肠动力指标MTL、CCK程负相关(r=-0. 632,-0. 678; P均<0. 05); VIP水平与胆道压力程正相关(r=0. 712; P <0. 05)。结论腹腔镜下胆道镜内镜联合钬激光碎石术治疗胆道结石临床效果明显,术后机体炎症反、胆道压力、胃肠动力指标更优,且胆道压力与胃肠动力指标具有一定相关性。
Objective To study the clinical effect of minimally invasive surgery and laparotomy in the treatment of cholelithiasis and the influence of postoperative biliary tract pressure and gastrointestinal function. The relationship between biliary tract pressure and gastrointestinal function was analyzed.Methods From January 2016 to January 2018,124 cases of cholelithiasis treated in our hospital were retrospectively analyzed. In the open group,60 patients were treated with open surgery. In the minimally invasive group,64 patients were treated with laparoscopic choledochoscopy combined with holmium laser lithotripsy. The incidence of postoperative complications, the level of blood inflammatory factors,gastrointestinal function and biliary pressure were measured and compared between the two groups. SPSS18.00 statistical software was used to analyze intraoperative and postoperative indexes. The inflammatory factors,postoperative biliary pressure and gastrointestinal motility were showed as x珋± s and compared with independent t test,χ2test was used to compare the stone residual rate and postoperative complications,the correlation analysis between biliary tract pressure and gastrointestinal motility was made by Spearman correlation analysis,P < 0. 05 was considered the difference was statistically significant. Results In the minimally invasive group,the operation time,hospitalization days,hospitalization expenses,residual stone rate and complication rate were better than those in the laparotomy group( P < 0. 05). The levels of serum IL-6,IL-8,TNF-α,MTL,CCK,VIP and biliary tract pressure in the minimally invasive group were significantly lower than those in the laparotomy group on the 3 d and 5 d after operation( P < 0. 05). There was a negative correlation between biliary tract pressure and gastrointestinal motility index( MTL,CCK course)( r = 0. 05,P < 0. 05,respectively),and there was a positive correlation between biliary tract pressure and the level of serum VIP( r = 0. 712,P < 0. 05). Conclusion Laparoscopic choledochoscopy combined with holmium laser lithotripsy is effective in the treatment of cholelithiasis. The postoperative inflammation factors,biliary tract pressure,gastrointestinal motility index are better. The biliary tract pressure is correlated with gastrointestinal motility.
Objective To study the clinical effect of minimally invasive surgery and laparotomy in the treatment of cholelithiasis and the influence of postoperative biliary tract pressure and gastrointestinal function. The relationship between biliary tract pressure and gastrointestinal function was analyzed.Methods From January 2016 to January 2018,124 cases of cholelithiasis treated in our hospital were retrospectively analyzed. In the open group,60 patients were treated with open surgery. In the minimally invasive group,64 patients were treated with laparoscopic choledochoscopy combined with holmium laser lithotripsy. The incidence of postoperative complications, the level of blood inflammatory factors,gastrointestinal function and biliary pressure were measured and compared between the two groups. SPSS18.00 statistical software was used to analyze intraoperative and postoperative indexes. The inflammatory factors,postoperative biliary pressure and gastrointestinal motility were showed as x珋± s and compared with independent t test,χ2test was used to compare the stone residual rate and postoperative complications,the correlation analysis between biliary tract pressure and gastrointestinal motility was made by Spearman correlation analysis,P < 0. 05 was considered the difference was statistically significant. Results In the minimally invasive group,the operation time,hospitalization days,hospitalization expenses,residual stone rate and complication rate were better than those in the laparotomy group( P < 0. 05). The levels of serum IL-6,IL-8,TNF-α,MTL,CCK,VIP and biliary tract pressure in the minimally invasive group were significantly lower than those in the laparotomy group on the 3 d and 5 d after operation( P < 0. 05). There was a negative correlation between biliary tract pressure and gastrointestinal motility index( MTL,CCK course)( r = 0. 05,P < 0. 05,respectively),and there was a positive correlation between biliary tract pressure and the level of serum VIP( r = 0. 712,P < 0. 05). Conclusion Laparoscopic choledochoscopy combined with holmium laser lithotripsy is effective in the treatment of cholelithiasis. The postoperative inflammation factors,biliary tract pressure,gastrointestinal motility index are better. The biliary tract pressure is correlated with gastrointestinal motility.
引文
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[11]胡志海,双金权.内镜下乳头括约肌切开联合柱状气囊扩张术治疗胆总管结石临床疗效分析[J].安徽医学,2016,37(9):1145-1147.
[12]黄树民.腹腔镜修补术与开腹修补术治疗胃穿孔术后胃肠动力恢复情况对比研究[J].临床和实验医学杂志,2016,15(24):2467-2469.
[13]宋勇罡,王崇高.腹腔镜联合胆道镜及钬激光行胆道碎石术后患者早期血清炎性介质和胆道压力水平的观察[J].中华全科医师杂志,2014,13(12):1006-1008.
[14]汪涛,朱永强,程龙.弥漫型肝内胆管结石的治疗策略[J].临床外科杂志,2015,23(12):895-897.
[2]苑军正,赵国强.三镜联合治疗胆道结石988例临床观察[J/CD].中华普外科手术学杂志:电子版,2015,9(1):35-38.
[3]胡钢,曹英豪,钱小星,等.加速康复外科在ERCP治疗胆道结石手术中的临床应用和体会[J].腹部外科,2017,30(5):365-368.
[4]中华医学会外科学分会胆道外科学组. 2011中国肝胆管结石病诊断治疗指南[M].北京:人民卫生出版社,2011.
[5]崔小红,政峰,肖长春,等.多种微创技术联合钬激光碎石治疗肝内胆管结石的临床疗效观察[J].川北医学院学报,2016,31(3):403-406.
[6]李华计.微创术式治疗胆道结石合并胆囊炎患者的应激反应探讨[J].中国老年保健医学,2017,15(6):93-94.
[7]林关朋,张萍,古永强,等.纤维胆道镜联合钬激光治疗胆道结石对患者血清CA19-9及CEA表达的影响[J].海南医学,2017,28(24):4004-4006.
[8]李震寰,黄卫华,黄晓方,等.腹腔镜联合胆道镜在治疗胆结石患者的临床效果分析[J/CD].中华普外科手术学杂志(电子版),2017,11(4):313-315.
[9]江哲龙,潘凡,吕立志,等.冷激光联合胆道镜治疗胆道术后残余结石效果分析[J].临床肝胆病杂志,2016,32(11):2138-2140.
[10]金俊哲,于浩,姜洪磊,等.纤维胆道镜下钬激光碎石术在治疗肝内外胆管结石中的应用[J].中国医科大学学报,2013,42(12):1141-1142.
[11]胡志海,双金权.内镜下乳头括约肌切开联合柱状气囊扩张术治疗胆总管结石临床疗效分析[J].安徽医学,2016,37(9):1145-1147.
[12]黄树民.腹腔镜修补术与开腹修补术治疗胃穿孔术后胃肠动力恢复情况对比研究[J].临床和实验医学杂志,2016,15(24):2467-2469.
[13]宋勇罡,王崇高.腹腔镜联合胆道镜及钬激光行胆道碎石术后患者早期血清炎性介质和胆道压力水平的观察[J].中华全科医师杂志,2014,13(12):1006-1008.
[14]汪涛,朱永强,程龙.弥漫型肝内胆管结石的治疗策略[J].临床外科杂志,2015,23(12):895-897.