双镜联合微创手术与开腹手术治疗复发性胆总管结石的临床效果对照研究OA

Objective:To investigate the effect of laparoscopic combined with choledochoscopy minimally invasive surgery in the treatment of patients with recurrent choledocholithiasis.Method:A prospective randomized study method was used to select 150 patients with recurrent choledocholithiasis treated in Songzi City People's Hospital from July 2020 to December 2022 as the study objects,and they were divided into minimally invasive group and control group by random number table method,with 75 cases in each group.The minimally invasive group was treated with laparoscopy combined with choledochoscope minimally invasive surgery,and the control group was treated with traditional open surgery.Perioperative indexes,serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),tumor necrosis factor-α(TNF-α),amylase and peripheral blood T lymphocyte levels before and after operation were compared between the two groups.The quality of life scores and the incidence of complications before and 1 week after operation were compared between the two groups.Result:The intraoperative blood loss and incision length in the minimally invasive group were lower than those in the control group(P<0.05),and the time of postoperative ground movement and hospital stay in the minimally invasive group were shorter than those in the control group(P<0.05).The operation time of minimally invasive group was longer than that of control group(P<0.05).Before surgery,there were no significant differences in serum ALT,AST,TNF-α and amylase levels between two groups(P>0.05);24 and 72 h after surgery,the levels of ALT,AST,TNF-α and amylase in minimally invasive group were lower than those in control group,the differences were statistically significant(P<0.05).Before surgery,there were no significant differences in the levels of peripheral blood CD3+,CD4+,CD8+ and CD4+/CD8+ between two groups(P>0.05);24 h after surgery,the levels of CD3+,CD4+/CD8+ in peripheral blood of the minimally invasive group were higher than those of the control group,and the levels of CD8+ were lower than those of the control group,the differences were statistically significant(P<0.05).Before surgery,there were no significant differences in SF-36 scores between the two groups(P>0.05);1 week after surgery,the scores of physiological function,physical pain,general health and mental health in the minimally invasive group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of complications in the minimally invasive group was 6.67%,lower than 20.00%in the control group,the difference was statistically significant(P<0.05).Conclusion:Compared with traditional open surgery,laparoscopic combined with choledochoscopy minimally invasive surgery in the treatment of patients with recurrent choledocholithiasis has less trauma,less influence on patients'liver function,inflammatory response,and serum amylase,and is conducive to improving patients'early postoperative quality of life.