摘要
目的对比分析不同术式治疗胆囊结石合并胆总管结石临床疗效研究及其对机体免疫功能的影响。方法选取自2014年2月至2016年5月期间,我院收治的90例胆囊结石合并胆总管结石患者进行回顾性研究分析。根据患者选取的治疗方法的不同分为观察组和对照组。采用常规开腹式手术进行治疗的45例患者为对照组,采用腹腔镜联合式手术进行治疗的45例患者为观察组。对比分析两组患者手术治疗的各项指标情况、VAS评分情况、术后镇痛药使用率、结石完全清除率、不同时间段免疫功能及并发症发生情况。结果观察组患者手术平均时间、术中出血量、术后首次通气时间、住院时间均少于对照组的患者(P<0.05)。术前两组患者的VAS评分相比差异无统计学意义(P>0.05);术后3 d、7 d、14 d,两组患的VAS评分与治疗前相比均有显著提高,且观察组患者的改善情况明显优于对照组(P<0.05)。观察组患者的术后镇痛药使用率为4.44%明显低于对照组的22.22%;观察组患者的术后结石完全清除率为95.56%明显高于对照组的77.78%(P<0.05)。两组患者经过治疗后免疫功能较治疗前T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8均有明显改善,且观察组的患者治疗后CD3为(57.3±6.4)%、CD4为(40.33±10.19)%、CD8为(22.5±2.8)%、CD4/CD8为(1.41±0.65)明显优于对照组患者的(60.5±5.2)%、(45.50±10.29)%、(24.7±2.5)%、(1.71±0.31)(P<0.05)。观察组患者在术后肝内胆汁淤积、肺部感染及切口感染的发生率均明显少于对照组(P<0.05)。结论腹腔镜联合式手术与传统的开腹式手术相比,疗效显著,不良反应小,对患者的免疫功能影响小,是一种安全有效的手术,在临床应进行推广和使用。
Objective To compare and analyze the clinical efficacy of different surgical treatment of gallstone and common bile duct stones, and to study the effect of different methods on the immune function of the body. Methods From February 2014 to May 2016, 90 cases of patients with gallstone and common bile duct stones in our hospital were retrospectively analyzed. According to the different treatment methods, the patients were divided into the experimental group and the control group. 45 patients were treated by conventional open surgery as control group, 45 cases were treated by laparoscopic combined surgery. The indexes of operation treat- ment, VAS score, postoperative analgesia drug use rate, total clearance rate of stones, the immune function and complications of two groups were compared and analyzed. Results The average time of operation, the amount of bleeding, the first aeration time and the length of stay in the observation group were less than those in the control group （P 〈 0. 05）. Preoperative patients in the two groups of VAS score difference was not statistically significant （P 〉 0. 05）. Postoperative 3D, 7 d, 14 d, patients in both groups VAS score be- fore treatment compared were significantly improved, and the observation group improved significantly better than the control group （P 〈 0. 05）. Observation group of postoperative analgesia drug use rate of 4. 44% was significantly lower than the control group of 22. 22%. Observation group patients after the stone complete clearance rate of 95. 56% was significantly higher than that of the control group of 77. 78% （ P 〈 0. 05）. Patients in the two groups after the treatment of immune function compared with the treatment of T lym- phocyte subsets CD3, CD4, CD8, CD4/CD8 had improved significantly and the observation group patients after treatment, the CD3 for （57. 3 ±6. 4）%, CD4 is （40. 33±＋10. 19）%, CD8 for （22. 5 ±2. 8）% and the ratio of CD4 / CD8 for （1. 41 ±0. 65） is obviously superior to the control group patients （60. 5 ± 5. 2 % ）, （45. 50±10. 29% ）, （24. 7 ± 2. 5 ）%, （1. 71 ±0. 31 ） （P 〈 0. 05 ）. In the observation group, the incidence of intrahepatic cholestasis, pulmonary infection and incision infection were significantly less than that in the control group （ P 〈 0. 05）. Conclusion By laparoscopy combined with type of eholecystolithiasis combined with choledocholith- iasis were surgical treatment has obvious curative effect, less adverse reaction, small influence of the immune function of patients, and traditional open surgery take stone method compared to has the advantages of high safety, time saving, labour saving, etc. , is a safe and effective operation, in clinical should be promotion and use.
出处
《肝胆外科杂志》
2016年第5期378-382,共5页
Journal of Hepatobiliary Surgery
关键词
胆囊结石合并胆总管
开腹式手术
腹腔镜联合式手术
免疫功能
Common bile duct stones and common bile duct
open surgery
laparoscopic combined surgery
immune function
