摘要
目的探讨腹腔镜联合胆道镜微创保胆取石术对胆囊结石患者胃肠功能及血清瘦素、内皮素的影响。方法选取2016年6月至2017年10月收治的胆囊结石患者87例,根据手术方式不同将其分为观察组(47例)和对照组(40例),对照组行腹腔镜胆囊切除术,观察组行腹腔镜联合胆道镜保胆取石术。比较两组患者术中术后情况、胃肠道功能、血清瘦素、内皮素水平及术后并发症。结果观察组患者术中出血量明显低于对照组[(16. 53±2. 72) ml vs(24. 75±4. 53) ml],但手术时间明显长于对照组[(75. 32±12. 05) min vs (53. 21±8. 15) min](P <0. 05);观察组患者饮食恢复时间[(1. 03±0. 26) d vs(1. 55±0. 46) d]、肠鸣音恢复时间[(0. 75±0. 12) d vs (0. 98±0. 13) d]、肛门排气时间[(1. 25±0. 17) d vs (1. 88±0. 46) d]及胃肠道不良反应发生率(29. 79%vs 57. 50%)均低于对照组(P <0. 05);两组患者术后胃动素及胃泌素均明显低于术前,且对照组患者术后胃动素及胃泌素均明显低于观察组[(178. 23±18. 14) pg/ml vs(201. 21±19. 05) pg/ml,(115. 05±10. 79) pg/ml vs(127. 36±8. 23) pg/ml](P <0. 05)。观察组患者术后血清瘦素水平较术前明显下降(P <0. 05),而对照组较术前无明显变化(P> 0. 05);两组患者术后内皮素水平均较术前明显上升,其中对照组上升幅度尤为明显(P <0. 05);两组并发症总发生率比较,差异无统计学意义(P> 0. 05)。结论腹腔镜联合胆道镜微创保胆取石术能够有效降低血清瘦素水平,减轻机体应激反应,且对胃肠道功能的影响较小。
Objective To explore the effects of minimally invasive gallbladder-preserving lithotomy with laparoscopy and choledochoscopy on gastrointestinal function,serum leptin and endothelin in patients with gallstone. Methods A total of 87 patients with gallbladder stone treated from June 2016 to October 2017 were selected and divided into observation group（n =47） and control group（n = 40） according to different surgical methods. The laparoscopic cholecystectomy was performed in control group,and laparoscopy combined with choledochoscopy for minimally invasive gallbladder-preserving lithotomy was performed in observation group. The intraoperative and postoperative conditions,gastrointestinal function,serum levels of leptin and endothelin and postoperative complications were compared between two groups. Results Intraoperative blood loss[（16. 53 ± 2. 72） ml vs（24. 75 ± 4. 53） ml] in observation group was significantly lower than that in control group,but operation time [（75. 32 ± 12. 05） min vs（53. 21 ± 8. 15） min] was significantly longer than that in control group（all P〈0. 05）. The recovery time of normal diet [（1. 03 ± 0. 26） d vs（1. 55 ± 0. 46） d ],bowel sounds [（0. 75 ± 0. 12） d vs（0. 98 ± 0. 13） d],anal exhaust time[（1. 25 ± 0. 17） d vs（1. 88 ± 0. 46） d] and the incidence of gastrointestinal adverse reactions（29. 79% vs 57. 50%） in observation group were statistically lower than those in control group（all P〈0. 05）.The motilin and gastrin levels after operation were significantly lower than those before operation in both two groups and were significantly lower in control group than those in observation group respectively [（178. 23 ± 18. 14） pg/ml vs（201. 21 ± 19. 05） pg/ml,（115. 05 ± 10. 79） pg/ml vs（127. 36 ± 8. 23） pg/ml,all P〈0. 05]. Serum leptin level in observation group decreased significantly after operation（P〈0. 05）,but there was no significant change in it before and after operation in control group（P〈0. 05）. There was no statistical difference in serum leptin level between two groups（P〈0. 05）. After operation,endothelin level was significantly higher than that before operation in both two groups and was statistically higher in control group than that in observation group（P〈0. 05）. There was no significant difference in total incidence of complications between two groups（P〈0. 05）. Conclusion Laparoscopy combined with choledochoscopy for minimally invasive gallbladder preserving lithotomy can effectively reduce serum leptin level and relieve stress reaction of the body. It has less influence on gastrointestinal function.
作者
张凌峰
黄汉民
莫正魁
ZHANG Ling-feng, HUANG Han-min, MO Zheng-kui(Department of Hepatobiliary Surgery, The First People＇s Hospital of Huaihua, Huaihua, Hunan 418000, China)
出处
《中国临床研究》
CAS
2018年第9期1198-1201,共4页
Chinese Journal of Clinical Research
基金
湖南省医药卫生科研计划项目(B2015-140)
关键词
胆囊结石
腹腔镜
胆道镜
双镜联合
胃肠道功能
瘦素
内皮素
Cholecystolithiasis
Laparoscopy
Choledochoscopy
Double lens combination
Gastrointestinal function
Leptin
Endothelin
