【摘要】 目的 观察腹腔镜胆囊切除(LC)与腹腔镜胆总管探查术(LCBDE)一步法术式对老年胆囊结石并胆总管结石患者炎症及免疫功能的影响.方法 选取104例老年胆囊结石并胆总管结石患者为研究对象，将其随机分为对照组和观察组.对照组52例给予序贯二步法内镜逆行胰胆管造影(ERCP)+LC治疗，观察组52例给予LC与LCBDE一步法治疗.比较两组手术一般资料、并发症情况，检测两组手术前后炎症因子水平水平、肝功能、免疫功能指标的差异.结果 观察组手术时间(126.14±13.32)min、肠鸣音恢复时间(21.03±3.77)h、排气时间(25.04±3.64)h及总住院时间(11.23±2.07)d均短于对照组，两组术中出血量和取石成功率比较差异无统计学意义(P>0.05).术前，两组炎症因子水平、肝功能、免疫功能指标比较差异无统计学意义(P>0.05),术后3 d,两组肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)等炎症因子水平及天冬氨酸转氨酶(AST)、丙氨酸转移酶(ALT)、总胆红素(TBIL)等肝功能指标较术前升高，两组CD4~+、CD8~+、CD4~+/CD8~+较术前下降，观察组术后3 d炎症因子水平低于对照组(均P<0.05),肝功能、免疫功能指标与对照组比较差异无统计学意义(P>0.05).观察组术后胆道感染、急性胰腺炎、术后出血、胆瘘等累计并发症发生率为7.69%(4/52),明显低于对照组的23.08%(12/52)(P<0.05).结论 在同样适应证的情况下，LC与LCBDE一步法对机体应激反应略轻，术后恢复快，且可减少术后并发症的发生，值得临床应用.更多还原

【Abstract】 Objective To observe the effects of laparoscopic cholecystectomy(LC) and laparoscopic common bile duct exploration(LCBDE) on inflammation and immune function in elderly patients with cholecystolithiasis and choledocholithiasis.Method A total of 104 elderly patients with cholecystolithiasis and common bile duct stones were selected as the research objects, and were randomly divided into control group and observation group.Fifty-two cases in the control group were given sequential two-step endoscopic retrograde cholangiopancr-eatography(ERCP)+LC treatment, while 52 cases in the observation group were given one-step treatment with LC and LCBDE.The general data and complications of two groups were compared, and the differences in inflammatory factors, liver function and immune function indexes before and after the operation were detected.Results The operation time of the observation group was(126.14±13.32) min, the recovery time of bowel sounds(21.03±3.77) h, the exhaust time(25.04±3.64) h and the total hospitalization time(11.23±2.07) d were all shorter than those of the control group.There was no statistical difference in intraoperative blood loss and stone removal success rate(P>0.05).Before operation, there was no statistical difference in the comparison of inflammatory factors, liver function and immune function indexes between the two groups(P>0.05),inflamm-atory factors such as interleukin-6(IL-6) and liver function indexes such as aspartate aminotransferase(AST),alanine transferase(ALT),and total bilirubin(TBIL) were higher than those before operation.CD4~+,CD8~+,CD4~+/CD8~+ decreased compared with those before operation, inflammatory factors in the observation group were lower than those in the control group after 3 days operation, and there was no significant difference in liver function and immune function indexes compared with the control group(P>0.05).The cumulative incidence of postoperative biliary tract infection, acute pancreatitis, postoperative bleeding, biliary fistula in the observation group was 7.69%(4/52),which was significantly lower than 23.08%(12/52) in the control group, with a statistical difference(P<0.05).Conclusion Under the same indications, the one-step method of LC and LCBDE has slightly less stress response to the body, quicker postoperative recovery, and can reduce the occurrence of postoperative complications, which is worthy of clinical application.更多还原