Effect of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis / 国际外科学杂志

ABSTRACT

Objective:To investigate the effect of laparoscopic cholecystectomy (LC) combined with common bile duct exploration (LCBDE) on pain stress and inflammatory factors in elderly patients with gallbladder stones and common bile duct stones.Methods:Eighty elderly patients with cholecystolithiasis and choledocholithiasis in Huadong Hospital Affiliated to Fudan University from January 2020 to January 2021 were selected. According to the surgical method, they were divided into observation group of 40 cases and control group of 40 cases. Patients in the observation group were treated with LC combined with LCBDE, and patients in the control group were treated with traditional open surgery. The perioperative indicators and complications, changes in pain stress and inflammatory factors before and 3 days after operation, and the quality of life before operation, 1 month after operation and 6 months after operation were compared between the two groups. Normally distributed measurement data were represented by mean±standard deviation ( Mean± SD), and t test was used to compare between groups. The chi-square test was used to compare the count data between groups. Results:The operation time, time to get out of bed, postoperative exhaust time, intraoperative blood loss, and postoperative complications in the observation group were (98.39±7.23) min, (1.56±0.37) d, (1.29±0.28) d, (38.94±5.64) mL, 5%, the control group were (107.53±9.98) min, (2.53±0.52) d, (2.16±0.34) d, (65.87±7.96) mL, 25%, the observation group were excellent in all indicators compared with the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum 5-hydroxytryptamine, substance P and norepinephrine in the two groups were higher than before operation ( P<0.05); after operation 3rd day, serum 5-hydroxytryptamine, substance P and norepinephrine the observation group were (0.70±0.12) pg/mL, (175.42±17.87) ng/mL and (378.52±26.57) ng/mL, the control group were (1.02±0.18) pg/mL, (248.98±18.98) ng/mL, and (460.92±35.42) ng/mL. The indexes of the observation group were smaller than those of the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the two groups were higher than before operation ( P<0.05); after operation 3rd day, Serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the observation group were (108.76±10.86) pg/mL, (14.23±3.18) mg/L and (17.84±3.98) pg/mL, respectively, on the 3rd day after operation. The control group were (156.95±16.67) pg/mL, (26.52±4.59) mg/L and (28.53±5.67) pg/mL, the observation group indexes were all smaller than control group, the differences between the two groups were statistically significant ( P<0.05). The quality of life scores of the two groups at 1 month and 6 months after the operation were higher than before operation ( P<0.05); The quality of life scores of patients in the observation group at 1 month and 6 months after surgery were higher than control group ( P<0.05). Conclusion:LC combined with LCBDE treatment has little effect on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis, and has fewer postoperative complications, and can improve the quality of life of patients.