关键词: 胆囊结石, 肝外胆管结石, 腹腔镜胆囊切除术, 内窥镜逆行胰胆管造影术, 内窥镜下括约肌切开术, 治疗

Abstract: Objective The aim of this study was to investigate whether the earlylaparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) is beneficialin the treatment of patients with simultaneous gallbladder and extrahepatic bile duct stones. Methods A retrospective analysis was performed on the clinical data of 65 patients with gallbladder and extrahepatic bile duct stones who were admitted to our hospital between April 2019 and April 2022, and all patients underwent ERCP and EST for removal of bile duct stones firstly. After that,35 patients in the observation group received LC within 48 h, and another 30 patients received in 48 h to 72 h later. Serum C-reactive protein (CRP) and peripheral blood white blood cell (WBC) counts were obtained. Serum interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) levels were assayed by ELISA. Results The intraoperative blood loss, hospital stay after operation and medical cost in the observation were (15.6±2.3)ml,(8.3±0.9)days and (19000±200)yuan, much less or shorter than [(34.7±4.1)ml, (12.3±1.5) days and (24000±300)yuan,P＜0.05] in the control, while there were no significant differences as respect to operation times for LC,the conversion rates to laparotomy and the stone clearance rates between the two groups (P>0.05); before and after the operation, there were no significant differences respect to serum bilirubin, AST, ALT and albumin levels between the two groups(P>0.05); after the operation, the WBC count and serum CRP level in the observation were (14.3±1.7)×10⁹/L and (25.5±2.3)mg/L, significantly higher than [(12.8±2.5)×10⁹/L and (18.7±3.4)mg/L, respectively, P＜0.05] in the control, while there were no significant differences as respect to serum IL-6 andTNF-α levels between the two groups [(33.1±6.5)μg/L and (21.8±2.7)μg/mL vs. (36.8±38.2)μg/L and (20.2±3.1)μg/mL, P＜0.05]; there was no significant difference in the incidence of postoperative complications between the two groups (8.6% vs. 23.3%, P>0.05). Conclusion For patients with simultaneous gallbladder and extrahepatic bile duct stones, the LCcould be performed early after ERCP and EST, which might shorten the hospitalization time, with relative less medical costs.

Key words: Gallbladder stone, Extrahepatic bile duct stone, Laparoscopic cholecystectomy, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Therapy