不同入路胆总管结石腹腔镜手术对患者炎性应激、胃肠功能、血清谷丙转氨酶和总胆红素水平的影响

Effects of different approaches in laparoscopic surgery for calculus of the common bile duct on inflammatory stress, gastrointestinal function and serum GPT and TBiL levels

摘要:

目的 探讨不同入路胆总管结石腹腔镜手术对患者炎性应激、胃肠功能、血清谷丙转氨酶（GPT）和总胆红素（TBiL）水平的影响。方法 选取2021年6月－2025年1月该院收治的胆总管结石患者75例，据手术入路的不同，分为A组（n = 37）和B组（n = 38）。A组行腹腔镜经胆囊管胆总管探查术（LTCBDE），B组行腹腔镜胆总管切开探查取石术（LCBDE）。比较两组患者的临床资料。结果 A组术中出血量明显少于B组，住院时间和结石最大直径明显短于B组，差异均有统计学意义（P < 0.05）；术后3 d，两组患者血清C反应蛋白（CRP）、降钙素原（PCT）和白细胞（WBC）水平较术前明显升高，但A组明显低于B组，差异均有统计学意义（P < 0.05）；A组肛门恢复排气时间、肠鸣音消失时间和腹痛缓解时间明显短于B组，差异均有统计学意义（P < 0.05）；术后3 d，两组患者血清GPT和TBiL水平明显低于术前，差异均有统计学意义（P < 0.05）；两组患者并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 LTCBDE与LCBDE治疗胆总管结石均具有较好的临床疗效，可有效地改善肝功能。其中，LTCBDE更有利于患者术后恢复，炎性应激反应更轻，胃肠功能恢复更好。

Abstract:

Objective To explore the effects of different approaches on inflammatory stress, gastrointestinal function and serum glutamic-pyruvic transaminase (GPT) and total bilirubin (TBiL) levels in patients undergoing laparoscopic surgery for calculus of the common bile duct.Methods From June 2021 to January 2025, 75 patients with calculus of the common bile duct admitted to Mianyang Hospital of Traditional Chinese Medicine were selected and divided into group A (n = 37) and group B (n = 38) according to different approaches. Group A underwent laparoscopic transcystic common bile duct exploration (LTCBDE), while group B underwent laparoscopic common bile duct exploration (LCBDE). The clinical data of the two groups were counted.Results The intraoperative blood loss in group A was less than that in group B, the hospitalization time and maximum diameter of stones in group A were shorter than those in group B, the differences were statistically significant (P < 0.05). Three days after operation, the serum levels of C-reactive protein (CRP), procalcitonin (PCT) and white blood cells (WBC) in both groups were significantly increased compared with those before the operation, but those in group A were significantly lower than those in group B, and the differences were statistically significant (P < 0.05). The time for the recovery of anal exhaust, the disappearance of bowel sounds and the relief of abdominal pain in group A were significantly shorter than those in group B, and the differences were statistically significant (P < 0.05). The serum GPT and TBiL levels 3 days after surgery in both groups were significantly decreased compared with those before the operation, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in the total incidence of complications between the two groups of patients (P > 0.05).Conclusion LTCBDE and LCBDE have good curative effects on calculus of the common bile duct, and can effectively improve liver function. Among them, LTCBDE is more conducive to the postoperative recovery of patients, reducing inflammatory stress and promoting the recovery of gastrointestinal function.