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