Zhang Chen, Feng Jian, Cai Wang, Zheng Mingwei, Lv Nan, Chen Boyu, Zhang Ruixue
Department of Hepato-Biliary-Pancreatic Surgery, Tianjin Nankai Hospital, Tianjin, China.
Department of Pharmacology, Tianjin Institute of Medicine and Pharmaceutical Science, Tianjin, China.
Wideochir Inne Tech Maloinwazyjne. 2023 Sep;18(3):494-501. doi: 10.5114/wiitm.2023.131076. Epub 2023 Sep 6.
Gallstones are a common digestive system disease.
To assess the effects of laparoscopic and choledochoscopic gallbladder-preserving cholecystolithotomy on the levels of operation indicators, gallbladder function, and cholecystokinin type-A receptor (CCKAR) in patients with gallstones.
The medical records of 100 patients with gallstones receiving operation from July 2019 to August 2022 were collected for retrospective analysis. They were divided into a laparoscopic group (n = 48) and a laparoscopic + choledochoscopic group (n = 52). The laparoscopic group received totally laparoscopic cholecystolithotomy, while the laparoscopic + choledochoscopic group underwent laparoscopic and choledochoscopic cholecystolithotomy. Their perioperative indicators, gallbladder function, stress indicators (cortisol (Cor), norepinephrine (NE), and C-reactive protein (CRP)), serum biochemical indicators (liver receptor homologue 1 (LRH-1), CCKAR, and vasoactive intestinal peptide (VIP)), and complications were compared.
The fasting gallbladder volume and gallbladder contraction rate increased, and the minimum residual volume and gallbladder wall thickness decreased in the laparoscopic + choledochoscopic group in comparison with those of the laparoscopic group 6 months after operation (p < 0.05). The levels of serum Cor, NE, CRP, and CCKAR were elevated, whereas the levels of serum LRH-1 and VIP were lowered in both groups 3 d after operation compared with those before operation (p < 0.05). The levels of serum Cor, NE, CRP, LRH-1, and VIP were lower, and the level of serum CCKAR was higher in the laparoscopic + choledochoscopic group than those in the laparoscopic group 3 d after operation (p < 0.05).
Both laparoscopic gallbladder-preserving cholecystolithotomy and laparoscopic and choledochoscopic cholecystolithotomy are effective for treating gallstones. However, the latter combination method is superior in enhancing postoperative gallbladder function, decreasing the recurrence risk, regulating the expressions of LRH-1, CCKAR, and VIP, and promoting the postoperative recovery of gastrointestinal function.
胆结石是一种常见的消化系统疾病。
评估腹腔镜联合胆道镜保胆取石术对胆结石患者手术指标水平、胆囊功能及胆囊收缩素 A 型受体（CCKAR）的影响。
收集 2019 年 7 月至 2022 年 8 月期间接受手术的 100 例胆结石患者的病历进行回顾性分析。将其分为腹腔镜组（n = 48）和腹腔镜联合胆道镜组（n = 52）。腹腔镜组接受全腹腔镜胆囊取石术，而腹腔镜联合胆道镜组则行腹腔镜联合胆道镜胆囊取石术。比较两组患者的围手术期指标、胆囊功能、应激指标（皮质醇（Cor）、去甲肾上腺素（NE）和 C 反应蛋白（CRP））、血清生化指标（肝脏受体同源物 1（LRH - 1）、CCKAR 和血管活性肠肽（VIP））及并发症。
与腹腔镜组相比，术后 6 个月腹腔镜联合胆道镜组的空腹胆囊容积和胆囊收缩率增加，最小残余容积和胆囊壁厚度减小（p < 0.05）。与术前相比，两组术后 3 d 血清 Cor、NE、CRP 和 CCKAR 水平升高，而血清 LRH - 1 和 VIP 水平降低（p < 0.05）。术后 3 d，腹腔镜联合胆道镜组血清 Cor、NE、CRP、LRH - 1 和 VIP 水平低于腹腔镜组，血清 CCKAR 水平高于腹腔镜组（p < 0.05）。
腹腔镜保胆取石术和腹腔镜联合胆道镜保胆取石术治疗胆结石均有效。然而，后一种联合方法在增强术后胆囊功能、降低复发风险、调节 LRH - 1、CCKAR 和 VIP 的表达以及促进术后胃肠功能恢复方面更具优势。
