关键词: 胆囊结石, 胆总管结石, 内镜下十二指肠乳头括约肌切开, 腹腔镜胆囊切除术

Abstract: Objective To explore the application effect of double-mirror surgical intervention in gallbladder stones combined with common bile duct stones and its impact on the prognosis of patients. Methods A total of 82 patients with gallbladder stones combined with common bile duct stones who were admitted to Anqiu People's Hospital from February 2023 to September 2024 were selected and divided into two groups according to different surgical methods, with 41 cases in each group. The control group was treated with open surgery, while the observation group was treated with endoscopic sphinc terotomy(EST) combined with laparoscopic cholecystectomy (LC). The effects of the patients in both groups were evaluated 2 weeks after the operation. The bilirubin levels, inflammatory factors, stress responses, stone clearance rates and the incidence of postoperative complications were compared between the two groups. Results Before the intervention, there was no statistically significant difference in the levels of total bilirubin (TBIL), indirect bilirubin (IBIL), and direct bilirubin (DBIL) between the two groups (P>; 0.05). After the intervention, the levels of TBIL, IBIL and DBIL in both groups were lower than those before the intervention, and those in the observation group were lower than those in the control group. The differences were statistically significant (P<; 0.05). Before the intervention, there was no statistically significant difference in the levels of tumor necrosis factor -α (TNF-α), interleukin-6 (IL-6), interleukin-17 (IL-17), and C-reactive protein (CRP) between the two groups (P>; 0.05). After the intervention, the levels of TNF-α, CRP, IL-6 and IL-17 in both groups were lower than those before the intervention, and those in the observation group were lower than those in the control group. The differences were statistically significant (P<; 0.05). Before the intervention, there was no statistically significant difference in the levels of norepinephrine (NE), cortisol (Cor), and C-peptide (CP) between the two groups (P>; 0.05). After the intervention, the levels of NE, Cor and CP in both groups were higher than those before the intervention, but those in the observation group were lower than those in the control group, and the difference was statistically significant (P<; 0.05). There was no statistically significant difference in the stone clearance rate between the two groups of patients (P>; 0.05). The incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P<; 0.05). Conclusion Surgical intervention based on double mirrors for the treatment of patients with gallbladder stones combined with common bile duct stones has a good effect. It can achieve a stone clearance rate similar to that of open surgery, help reduce the bilirubin level of patients, alleviate the inflammatory response of the body, cause less stress response during surgery, and have a lower incidence of postoperative complications. It is worthy of application.

Key words: gallbladder stones, common bile duct stones, endoscopic sphinc terotomy, laparoscopic cholecystectomy