腹腔镜胆总管探查取石术后一期缝合对胆总管结石患者应激反应、胃肠功能及并发症的影响

Effect of primary closure of LCBD on stress response, gastrointestinal function and complications after laparoscopic choledocholithotomy

摘要:

目的 探讨腹腔镜胆总管探查取石术后一期缝合对胆总管结石患者应激反应、胃肠功能及并发症的影响。方法 回顾性分析2017年6月－2019年6月在该院进行腹腔镜胆总管探查取石术的70例胆总管结石患者的临床资料，依据胆总管缝合方式不同分为A组（胆总管探查取石术后一期缝合）39例和B组（胆总管探查取石术后T管引流）31例。对比两组患者术后血清应激反应指标、胃肠功能恢复指标及并发症发生率情况。结果 两组患者肾上腺素（A）、促肾上腺皮质激素（ACTH）及皮质醇（COR）水平组间、时间、交互作用比较，差异均有统计学意义（P < 0.05）；与术前（T₁）相比，术后3 d（T₂）两组患者A、COR及ACTH水平均升高（P < 0.05），术后1周（T₃），B组A、COR及ACTH水平均升高（P < 0.05）；与T₂时刻相比，T₃时刻两组患者A、COR及ACTH水平均降低（P < 0.05）；A组T₂及T₃时刻A、COR及ACTH水平均低于B组（P < 0.05）；A组术后排气时间及术后首次排便时间均明显早于B组（P < 0.05）；A组术后并发症总发生率为5.13%，明显低于B组的25.81%（P < 0.05）。结论 腹腔镜胆总管探查取石术后一期缝合可减轻胆总管结石患者术后应激反应、改善胃肠功能、有助于降低术后并发症发生率。

Abstract:

Objective To investigate the effect of primary closure of LCBD on stress response, gastrointestinal function and complications after laparoscopic choledocholithotomy in patients with choledocholithiasis.Methods A retrospective analysis was made of 70 patients with choledocholithiasis underwent laparoscopic choledocholithotomy from June 2017 to June 2019. According to the different suture methods of common bile duct, they were divided into group A (primary closure of CBD after choledocholithotomy) 39 cases and group B (T-catheter drainage after choledocholithotomy) 31 cases. The indexes of serum stress reaction, gastrointestinal function recovery and the incidence of complications were compared between the two groups.Results The levels of adrenaline (A), cortisol (COR) and adrenocorticotropic hormone (ACTH) in the two groups were statistically significant compared with each other in group, time and interaction (P < 0.05). Compared with preoperative (T₁), the levels of A, COR and ACTH in the two groups were significant higher at 3 d after operation (T₂) (P < 0.05), and the levels of A, COR and ACTH in the B group at 1 week after operation (T₃) were significant higher (P < 0.05) . Compared with T₂ moment, the levels of A, COR and ACTH in the two groups were significant lower at T₃ (P < 0.05). The levels of A, COR and ACTH in group A were significant lower than those in group B at T₂ and T₃ (P < 0.05). The time to first flatus and time to first defecation after operation in group A was significantly shorter than that in group B (P < 0.05). The incidence of postoperative complications in group A was 5.13%, which was significantly lower than that of 25.81% in group B (P < 0.05).Conclusion Primary suture after laparoscopic choledocholithotomy can reduce postoperative stress response, improve gastrointestinal function and reduce the incidence of postoperative complications in patients with choledocholithiasis.