标题：LCBDE联合LC治疗结石性AOSC的疗效及对患者炎症因子和预后的影响

      作者：曹汉彬，王长庆，冉文斌，贾生雄，赵伟，秦占坤    西安宝石花长庆医院普通外科，陕西 西安 710201

      卷次： 2023年34卷16期

      【摘要】 目的 探讨腹腔镜胆总管切开探查取石术(LCBDE)联合腹腔镜胆囊切除术(LC)治疗结石性急性梗阻性化脓性胆管炎(AOSC)的疗效及对患者炎症因子水平的影响。方法 回顾性分析2018年1月至2022年1月于西安宝石花长庆医院诊治的的 80例结石性AOSC患者的临床资料，依据术式不同分为对照组和研究组各 40例。对照组患者接受内镜下括约肌切开取石术(EST)+LC治疗，研究组患者接受LCBDE+LC治疗。比较两组患者术后7 d的临床疗效、术中出血量、手术时间、术后下床活动时间、残留结石直径及术前与术后3 d炎症因子[包括白细胞介素-6 (IL-6)、C反应蛋白(CRP)及肿瘤坏死因子-α (TNF-α)]水平。结果 研究组患者的治疗总有效率为95.00%，明显高于对照组的72.50%，差异有统计学意义(P<0.05)；研究组患者的术中出血量、术后下床活动时间、残留结石直径分别为(46.26±13.19) mL、(1.02±0.05) d、(4.08±1.58) mm，明显少于或短于对照组的(94.96±27.16) mL、(1.47±0.26) d、(6.35±1.02) mm，差异均有统计学意义(P<0.05)；研究组和对照组患者的手术时间分别为(129.07±30.87) min，(133.45±39.25) min，差异无统计学意义(P>0.05)；术前，两组患者的 IL-6、CRP、TNF-α水平比较差异均无统计学意义(P>0.05)；术后3 d，研究组患者的 IL-6、CRP、TNF-α水平分别为(17.87±4.01) pg/mL、(14.22±3.23) mg/L、(109.42±10.93) pg/mL，明显低于对照组的(28.46±5.73) pg/mL、(26.47±4.60) mg/L、(157.04±16.58) pg/mL，差异均有统计学意义(P<0.05)；研究组患者术后并发症总发生率为 5.00%，明显低于对照组的 20.00%，差异有统计学意义(P<0.05)。结论 LCBDE联合LC治疗结石性AOSC能显著改善患者的炎症因子水平，临床疗效显著，且安全性较高。
      【关键词】 结石性急性梗阻性化脓性胆管炎；胆总管切开探查取石术；胆囊切除术；临床疗效；炎症因子
      【中图分类号】 R657.4 【文献标识码】 A 【文章编号】 1003—6350（2023）16—2327—04

Efficacy of laparoscopic choledocholithotomy combined with laparoscopic cholecystectomy in the treatment ofpatients with calculous acute obstructive suppurative cholangitis and its influence on inflammatory factors andprognosis.
CAO Han-bin, WANG Chang-qing, RAN Wen-bin, JIA Sheng-xiong, ZHAO Wei, QIN Zhan-kun. Deparment ofGeneral Surgery, Gem Flower Xi'an Changqing Staff Hospital, Xi'an 710201, Shaanxi, CHINA
【Abstract】 Objective To investigate the efficacy of laparoscopic choledocholithotomy (LCBDE) combinedwith laparoscopic cholecystectomy (LC) in the treatment of calculous acute obstructive suppurative cholangitis (AOSC)and its effect on the level of inflammatory factors and prognosis. Methods The clinical data of 80 patients with AOSCdiagnosed and treated in Gem Flower Xi'an Changqing Staff Hospital from January 2018 to January 2022 were retrospec-tively analyzed. The patients were divided into a control group and a study group according to different surgical meth-ods, with 40 patients in each group. The control group received endoscopic sphincterotomy (EST)+LC treatment, and thestudy group received LCBDE+LC treatment. The clinical efficacy at 7 days after operation, intraoperative blood loss,operation time, postoperative ambulation time, residual stone diameter, and inflammatory factor levels before and 3 daysafter surgery [including interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α)] werecompared between the two groups. Results The total effective rate in the study group was 95.00%, significantly higherthan 72.50% in the control group (P<0.05). The intraoperative blood loss, postoperative ambulation time, and residualstone diameter in the study group were (46.26±13.19) mL, (1.02±0.05) d, and (4.08±1.58) mm, significantly less/shorterthan (94.96±27.16) mL, (1.47±0.26) d, and (6.35±1.02) mm in the control group (P<0.05). The operation time was(129.07±30.87) min in the study group, which showed no statistically significant difference with (133.45±39.25) min in thecontrol group (P>0.05). Before surgery, IL-6, CRP, TNF-α showed no statistically significant difference between the twogroups (P>0.05); at 3 d after operation, the levels of IL-6, CRP, and TNF-α in the study group were (17.87±4.01) pg/mL,(14.22 ± 3.23) mg/L, and (109.42 ± 10.93) pg/mL, significantly lower than (28.46 ± 5.73) pg/mL, (26.47 ± 4.60) mg/L,(157.04±16.58) pg/mL in the control group (P<0.05). The incidence of complications in the study group was 5.00%, sig-nificantly lower than 20.00% in the control group (P<0.05). Conclusion LCBDE combined with LC in the treatmentof calculous AOSC can significantly improve the level of inflammatory factors in patients, with significant clinical effica-cy and high safety.
      【Key words】 Calculous acute obstructive suppurative cholangitis; Laparoscopic choledocholithotomy; Cholecys-tectomy; Clinical efficacy; Inflammatory factors