LC联合LCBDE同步手术治疗胆囊结石合并胆总管结石患者临床疗效研究*

doi:10.3969/j.issn.1672-5069.2023.04.031

摘要/Abstract

摘要： 目的分析比较采用腹腔镜胆囊切除术(LC)联合腹腔镜胆总管探查(LCBDE)同步手术与采用内镜下括约肌切开术(EST)联合后续LC治疗胆囊结石合并胆总管结石(CCWC)患者的效果差异。方法 2017年9月～2021年9月我院收治的CCWC患者73例被分为两组,39例观察组接受LC联合LCBDE同步手术治疗,34例对照组接受EST联合后续LC治疗,术后随访12个月。采用视觉模拟评分法(VAS)评估疼痛程度,采用ELISA法检测血清C反应蛋白(CRP),常规检测血常规。结果两组结石残留率为5.1%对2.9%,无显著性差异(P＞0.05),观察组手术时间为(140.1±35.2)min,显著长于对照组【(119.7±30.4) min,P＜0.05】,住院时间为(10.9±2.1)d,显著短于对照组【(14.5±2.6) d,P＜0.05】,VAS评分为(2.3±0.4)分,显著低于对照组【(3.1±0.7),P＜0.05】,镇痛泵应用率为35.9%,显著低于对照组(61.8%,P＜0.05);术后5 d,观察组血清C反应蛋白水平为(71.5±16.1)mg/L,显著低于对照组【(90.1±20.4) mg/L,P＜0.05】,外周血WBC计数为(9.3±1.4)×10⁹/L,显著低于对照组【(11.3±1.8)×10⁹/L,P＜0.05】,中性粒细胞百分比为为(74.5±6.9)%,显著低于对照组【(82.9±7.5)%,P＜0.05】;术后,观察组切口感染、胰腺炎、腹腔内出血、胆漏和反流性胆管炎等发生率为18.0%,显著低于对照组的38.2%(P＜0.05);两组结石复发率比较无显著性差异(5.1%对8.8%,P＞0.05)。结论采用LC联合LCBDE同步手术治疗CCWC患者可缩短住院时间,减少并发症的发生。

关键词: 胆囊结石, 胆总管结石, 腹腔镜胆囊切除术, 腹腔镜胆总管探查, 内镜下括约肌切开术, 治疗

Abstract: Objective The aim of this study was to investigate the immediate laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in treatment of patients with simultaneous cholecystolithiasis and choledocholithiasis. Methods 73 patients with simultaneous cholecystolithiasis and choledocholithiasis were encountered in our hospital between September 2017 and September 2021, and were randomly divided into observation (n=39) and control (n=34) groups. The patients in the observation group received LC and immediate LCBDE, and those in the control received endoscopic sphincterotomy (EST) followed by LC three days later. All patients were followed-up for 12 months after surgery. The pain was evaluated by visual analogue scale (VAS) and serum C-reactive protein (CRP) level was detected by ELISA. The peripheral blood white blood cell (WBC) counts and the percentages of neutrophil cells (NEUT) were routinely obtained. Results There was no significant difference in stone residual rate between the two groups (5.1% vs. 2.9%, P>0.05); the operation time in the observation group was significantly longer than that in the control group [(140.1±35.2) min vs. (119.7±30.4)min, P<0.05], while the hospitalization time was significantly shorter than that in the control group [(10.9±2.1)d vs. (14.5±2.6)d, P<0.05], the VAS score was significantly lower than that in the control group [(2.3±0.4) vs. (3.1±0.7), P<0.05], and the percentages of persistent analgesia pump needed was significantly lower than that in the control group (35.9% vs. 61.8%, P<0.05); at day 5 after surgery, serum CRP level in the observation was(71.5±16.1)mg/L, much lower than [(90.1±20.4) mg/L, P＜0.05], the WBC count was (9.3±1.4)×10⁹/L, much lower than [(11.3±1.8)×10⁹/L, P＜0.05], and the percentage of NEUT cells was (74.5±6.9)%, much lower than [(82.9±7.5)%, P＜0.05] in the control; the incidences of post-operational complications, such as infection, bleeding, pancreatitis, bile leakage and reflux cholangitis in the observation was 18.0%, much lower than 38.2%(P＜0.05) in the control; at the end of 12 month follow-up, there was no significant difference in the recurrence rate of stones between the two groups (5.1% vs. 8.8%, P>0.05). Conclusion The LC and immediate LCBDE in the treatment of patients with simultaneous cholecystolithiasis and choledocholithiasis could shorten hospital stay times, with reduced post-operational complications.

Key words: Cholecystolithiasis, Choledocholithiasis, Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration, Endoscopic sphincterotomy, Therapy

刘泽军, 慕海峰, 陈升宝, 王春, 徐刚. LC联合LCBDE同步手术治疗胆囊结石合并胆总管结石患者临床疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(4): 576-579.

Liu Zejun, Mu Haifeng, Chen Shengbao, et al. Immediate laparoscopic cholecystectomy and laparoscopic common bile duct exploration in treatment of patients with simultaneous cholecystolithiasis and choledocholithiasis[J]. Journal of Practical Hepatology, 2023, 26(4): 576-579.

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LC联合LCBDE同步手术治疗胆囊结石合并胆总管结石患者临床疗效研究^*

Immediate laparoscopic cholecystectomy and laparoscopic common bile duct exploration in treatment of patients with simultaneous cholecystolithiasis and choledocholithiasis

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