目的 探讨腹腔镜手术联合依泽替米贝治疗胆囊结石患者的效果及对血清胆囊收缩素A(cholecystokinin A,CCK-A)、胆固醇调节元件结合蛋白2(cholesterol regulatory element binding protein 2、SREBP-2)的影响。方法 选取2016-08至2018-08医院收治的胆囊结石患者120例,按照入院先后编号,采用随机信封法分为治疗组和对照组,每组60例。对照组进行三孔法腹腔镜联合胆道镜保胆取石术,治疗组在对照组腹腔镜手术的基础上加用依泽替米贝。分别于治疗前和术后检查胆囊内结石数量和直径,并检测TNF、IL-1、CCK-A、SREBP-2的表达水平。结果 治疗组有效率为93.33%,对照组有效率为76.67%,两组差异有统计学意义(P<0.05)。治疗后两组患者结石数量和直径均减小,治疗组胆囊结石数量和直径明显小于对照组,差异有统计学意义(P<0.05)。治疗前两组患者血清TNF、IL-1、CCK-A、SREBP-2差异无统计学意义,治疗后治疗组血清TNF、IL-1、CCK-A,与对照组相比,差异均有统计学意义(P<0.05)。结论 依泽替米贝联合腹腔镜微创手术可明显缓解患者临床症状,预防和减缓胆囊结石的形成,减轻机体炎性反应,减少胆固醇的吸收,恢复胆囊收缩功能。

Objective To investigate the efficacy of laparoscopic minimally invasive surgery combined with ezetimibe in the treatment of cholecystolithiasis and its influence on serum CCK-A and SREBP-2 levels.Methods A total of 120 patients with gallstones diagnosed in our hospital between August 2016 and August 2018) were selected and divided into the experimental group and control group using the random envelope method and according to the admission time, with 60 cases in each group.The control group underwent three-port laparoscopic choledochoscopic cholelithotripsy while the experimental group received ezetimibe as well as laparoscopic minimally invasive surgery. The curative effect was evaluated according to the clinical symptoms and signs of the patients. The number and diameter of gallstones were examined before and after treatment, and the expression levels of TNF, IL-1, CCK-A and SREBP-2 were detected.Results The effective rate was 93.33% in the experimental group and 76.67% in the control group. There was no significant difference in the number and diameter of gallstones between the two groups before treatment (P>0.05). After treatment, the number and diameter of gallstones in both groups decreased. They were smaller in the experimental group than in the control group (P<0.05). There was no significant difference in serum levels of TNF, IL-1, CCK-A and SREBP-2 between the two groups before treatment. After treatment, serum levels of TNF, IL-1 and SREBP-2 decreased while CCK-A increased in the two groups, espeically in the experimental group (P<0.05).There was no significant difference in the gallstone diameter between the two groups before treatment. After treatment, the number and diameter of gallstones in both groups decreased, and the diameter of gallstones in the experimental group was smaller than that in the control group (P< 0.05).The incidence of adverse reactions was 10.00% in the experimental group and 6.67% in the control group, but the difference was of no statistical significance.Conclusions Ezetimibe combined with laparoscopic minimally invasive surgery can significantly alleviate the clinical symptoms of patients, prevent and slow down the formation of gallstones, alleviate inflammation, reduce cholesterol absorption, and restore gallbladder contractile function.