腹腔镜联合术中胆道镜治疗胆囊结石合并肝外胆管结石患者疗效研究

doi:10.3969/j.issn.1672-5069.2021.02.033

摘要/Abstract

摘要： 目的探讨采用腹腔镜联合术中胆道镜治疗胆囊结石合并肝外胆管结石患者的疗效及血清血管紧张素I(AngI)、AngⅡ和Ang1-7水平的变化。方法在105例胆囊结石合并肝外胆管结石患者中,53例接受腹腔镜联合术中胆道镜手术治疗,52例(对照组)接受开腹手术治疗。使用流式细胞仪检测全血CD4⁺和CD8⁺细胞百分比,采用免疫比浊法检测血清免疫球蛋白E(IgE)、IgG和IgA水平,采用ELISA法检测血清AngI、AngⅡ和Ang1-7水平。结果观察组手术时间为(98.7±2.8)min,显著短于对照组【(123.6±5.3)min,P<0.05】,切口长度为(3.0±1.0)cm,显著短于对照组【(9.1±1.6)cm,P<0.05】,术中出血量为(21.8±2.5)mL,显著少于对照组【(43.7±2.9)mL,P<0.05】,术后排气时间为(25.1±2.1)h,显著短于对照组【(47.3±3.3)h,P<0.05】;术后3 d,观察组血清AngI水平为(10.3±1.8)ng/mL,显著低于对照组【(14.9±1.9)ng/mL,P<0.05】,血清AngⅡ水平为(51.4±5.0)ng/L,显著低于对照组【(66.2±7.2)ng/L,P<0.05】,血清Ang1-7水平为(413.5±43.7)ng/L,显著低于对照组【(522.7±63.4)ng/L,P<0.05】;全血CD4⁺细胞百分比为(32.4±1.1)%,显著高于对照组【(28.5±1.2)%,P<0.05】,而CD8⁺细胞百分比为(22.0±1.2)%,显著低于对照组【(25.9±1.0)%,P<0.05】,CD4⁺/CD8⁺细胞比值为(1.4±0.1),显著高于对照组【(1.1±0.1),P<0.05】;血清IgE水平为(11.4±0.5)g/L,显著高于对照组【(9.2±0.4)g/L,P<0.05】,血清IgG水平为(2.5±0.3)g/L,显著高于对照组【(2.2±0.2)g/L,P<0.05】,血清IgA水平为(1.6±0.2)g/L,显著高于对照组【(1.4±0.1)g/L,P<0.05】;观察组术后并发症发生率为5.7%,显著低于对照组(21.2%,P<0.05)。结论采用腹腔镜联合术中胆道镜治疗胆囊结石合并肝外胆管结石患者可改善手术相关指标,抑制血管紧张素的分泌,降低机体应激反应,减少术后并发症的发生。

关键词: 胆囊结石, 肝外胆管结石, 腹腔镜, 胆道镜, 血管紧张素1-7, 治疗

Abstract: Objective To explore the efficacy of laparoscopic cholecystectomy (LC) and intraoperative choledochoscopy for the treatment of patients with gallbladder stones and extrahepatic bile duct stones.Methods A retrospective study on 105 patients with gallbladder stones and extrahepatic bile duct stones was performed, and 53 patients received LC and intraoperative choledochoscopy and 52 received open surgery. The flow cytometry was applied to detect the percentages of peripheral blood CD4⁺ and CD8⁺ cells and ratio of CD4⁺/CD8⁺ cells, serum immunoglobulin E (IgE), IgG and (IgA levels were assayed by immunoturbidimetry, and serum angiotensin I (AngI), AngⅡ and Ang1-7 levels were detected by ELISA.Results The operation time in the combination group was (98.7±2.8) min, significantly shorter than that in the control group [(123.6±5.3) min, P<0.05], the incision length was (3.0±1.0) cm, significantly shorter than that in the control group [(9.1±1.6) cm, P<0.05], the intraoperative blood loss was (21.8±2.5) mL, significantly less than that in the control group [(43.7±2.9) mL, P<0.05], and the postoperative exhaust time was (25.1±2.1) h, significantly shorter than in the control group [(47.3±3.3) h,P<0.05]; 3 d after operation, serum AngI level in the combination group was ( 10.3±1.8) ng/mL, significantly lower than [(14.9±1.9) ng/mL, P<0.05], serum AngⅡ level was (51.4±5.0) ng/L, significantly lower than [(66.2±7.2) ng/L, P<0.05], and serum Ang1-7 level was (413.5±43.7) ng/L, significantly lower than [(522.7±63.4) ng/L, P<0.05] in the control; the percentage of blood CD4⁺ cells was (32.4±1.1)%, significantly higher than [(28.5±1.2)%, P<0.05], while that of CD8⁺ cells was (22.0±1.2)%, significantly lower than 【(25.9±1.0)%, P<0.05】, and the ratio of CD4⁺/CD8⁺ cells was(1.4±0.1), significantly higher than 【(1.1±0.1), P<0.05】 in the control; serum IgE level was(11.4±0.5)g/L, significantly higher than 【(9.2±0.4)g/L, P<0.05】, serum IgG level was (2.5±0.3)g/L, significantly higher than 【(2.2±0.2)g/L, P<0.05】, and serum IgA level was (1.6±0.2)g/L, significantly higher than 【(1.4±0.1)g/L, P<0.05】 in the control; the incidence of postoperative complications in the combination group was 5.7%, significantly lower than 21.2% in the control (P<0.05).Conclusion The combined application of LC and intraoperative choledochoscopy in the treatment of patients with gallstones and extrahepatic bile duct stones could inhibit the secretion of angiotensin, reduce the body's stress response, and decrease the incidence of postoperative complications.

Key words: Gallbladder stones, Extrahepatic bile duct stones, Laparoscopic cholecystectomy, Angiotensin 1-7, Surgery

庞武, 陈莉红, 朱宇, 吴涯昆. 腹腔镜联合术中胆道镜治疗胆囊结石合并肝外胆管结石患者疗效研究[J]. 实用肝脏病杂志, 2021, 24(2): 280-283.

Pang Wu , Chen Lihong, Zhu Yu, et al. Laparoscopic cholecystectomy and intraoperative choledochoscopy for the treatment of patients with gallbladder stones and extrahepatic bile duct stones[J]. Journal of Practical Hepatology, 2021, 24(2): 280-283.

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