关键词: 腹腔镜, 胆管镜, 胆囊结石, 胆总管结石, 炎症因子, 应激反应

Abstract:

Objective To study the clinical effect of laparoscopic combined with choledochoscopy in the treatment of patients with gallstones and common bile duct stones. Method 60 patients with cholecystolithiasis and choledocholithiasis who were admitted to the 946 Army Hospital of the People's Liberation Army from January 2023 to December 2024 were selected and grouped according to the random number table. The control group (n=30) underwent laparoscopic common bile duct incision and stone removal surgery for treatment, while the observation group (n=30) underwent laparoscopic combined bile duct exploration and stone removal surgery through the gallbladder duct. The perioperative indicators, levels of infl ammatory factors, stress response indicators, and incidence of postoperative complications were compared between the two groups of patients. Result The intraoperative bleeding volume of patients in the observation group was less than that in the control group, and the hospitalization time, surgical time, incision healing time, fi rst mobilization time, fi rst anal exhaust time, and bowel sound recovery time were all signifi cantly shorter than those in the control group (P ＜ 0.001). Before treatment, there was no signifi cant diff erence in the levels of infl ammatory factors and stress response indicators between the two groups of patients (P ＞ 0.05); After treatment, the levels of T tumor necrosis factor-α, interleukin-6, C reactive protein, and serum amylase in the observation group were lower than those in the control group, and the levels of adrenaline and superoxide dismutase were lower than those in the control group. The levels of malondialdehyde were higher than those in the control group, and the diff erences were signifi cant (P ＜ 0.05). After surgery, there was 1 case of bile leakage and 1 case of infection in the observation group, with a total incidence of complications of 6.67%; The control group experienced 3 cases of bile leakage, 2 cases of abdominal infection, and 2 cases of bile duct bleeding. The total incidence of postoperative complications in the observation group was lower than that in the control group (23.33%), and the diff erence was signifi cant (χ2=5.192, P=0.023). Conclusion The treatment of patients with gallstones combined with common bile duct stones through laparoscopic and choledochoscopy exploration of the gallbladder duct and bile duct can promote patient recovery, reduce the risk of postoperative complications, and improve infl ammatory factors and stress indicators.

Key words: Laparoscopy, Choledochoscopy, Gallstones, Common bile duct stones, Inflammatory factors, Stress response indicators