腹腔镜与胆道镜双镜联合治疗复发性胆总管结石患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.02.037

摘要/Abstract

摘要： 目的分析腹腔镜联合胆道镜探查治疗胆道手术后再发胆总管结石患者的疗效。方法 2022年1月～2024年6月我院收治的胆道手术后再发的胆总管结石患者108例,被分为A组45例,采用腹腔镜联合胆道镜探查治疗,和B组63例,采用内镜逆行胰胆管造影(ERCP)/内镜下Oddi's括约肌切开取石术(EST)治疗,随访6个月。采用ELISA法检测血清内毒素(ET)水平,常规检测血清D-乳酸水平。结果 A组手术时间、术后住院日和住院费用分别为(102.8±19.1)min、(8.4±1.6)d和(2.6±0.4)万元,均显著多于或长于B组【分别为(81.5±14.6)min、(5.1±1.3)d和(1.9±0.4)万元,P<0.05】;在术后3 d,A组血清ET和D-乳酸水平分别为(7.8±1.7)g/L和(0.5±0.1)mmol/L,与B组【分别为(8.6±1.9)g/L和(0.6±0.1)mmol/L】比,无显著性差异(P>0.05);A组血清ALT、TBIL和ALB水平分别为(45.6±5.8)U/L、(17.2±3.3)μmol/L和(35.7±5.1)g/L,与B组【分别为(43.8±6.0)U/L、(16.4±3.5)μmol/L和(34.6±4.7)g/L】比,无显著性差异(P>0.05);两组术后胆道感染、出血、胆漏和急性胰腺炎等并发症发生率(11.1%对19.1%)比较,无显著性差异(P>0.05);随访6个月,超声检查发现A组无结石复发(0.0%),B组发生结石复发6例(9.5%)。结论采用腹腔镜联合胆道镜探查取石术或ERCP/EST治疗胆道手术后再发性胆总管结石患者的疗效相当,两种方式治疗结石清除率均较高,但后者似乎更容易发生结石复发,值得长期观察。

关键词: 胆总管结石, 腹腔镜, 胆道镜, 内镜逆行胰胆管造影, 内镜下Oddi&apos, s括约肌切开取石术, 治疗

Abstract: Objective The aim of this study was to investigate clinical efficacy of laparoscopic cholecystectomy (LC) and choledochoscopy combination in the treatment of patients with recurrent common bile duct stones after biliary tract surgery. Methods 108 patients with recurrent choledocholithiasis who had had biliary tract surgery were enrolled in our hospital between January 2022 and June 2024, and were randomly divided into group A (n=45) and group B (n=63), receiving LC and choledochoscopy combination, or endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST), and all patients were followed-up for 6 months. Serum endotoxin (ET) level was detected by ELISA, and serum D-lactic acid level was routinely obtained. Results Surgical time, postoperative hospital stay and medical cost in group A were(102.8±19.1)min,(8.4±1.6)d and (20.6±4.0)thousand yuan, all significantly greater or longer than [(81.5±14.6)min, (5.1±1.3)d and (19.0±4.0)thousand yuan, respectively, P<0.05]; three days after surgery, serum ET and D-lactic acid levels in group A were(7.8±1.7)g/L and (0.5±0.1)mmol/L, both not significantly different as compared to [(8.6±1.9)g/L and (0.6±0.1)mmol/L, respectively] in group B(P>0.05); serum ALT, total bilirubin and albumin levels were (45.6±5.8)U/L, (17.2±3.3)μmol/L and (35.7±5.1)g/L, also not significantly different compared to [(43.8±6.0)U/L, (16.4±3.5)μmol/L and (34.6±4.7)g/L, respectively] in group B (P>0.05); incidences of post-operational complications, such as biliary infection, bleeding, bile leakage and acute pancreatitis in the two groups(11.1% vs. 19.1%) was not much different(P>0.05); by end of six-month follow-up, ultrasonography found no stone recurred in group A, but stone recurred in six cases(9.5%)in group B. Conclusion The efficacy of LC and choledochoscopy combination or ERCP/EST in the treatment of patients with recurrent common bile duct stones after biliary tract surgery is both satisfactory, but it seems more post-operational stone recurrence found after ERCP/EST, which needs further observation.

Key words: Choledocholithiasis, Laparoscopic cholecystectomy, Choledochoscopy, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Therapy

翟鹏, 张华国, 蒋永军. 腹腔镜与胆道镜双镜联合治疗复发性胆总管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 306-309.

Zhai Peng, Zhang Huaguo, Jiang Yongjun. Laparoscopic cholecystectomy and choledochoscopy combination in the treatment of patients with recurrent common bile duct stones after biliary tract surgery[J]. Journal of Practical Hepatology, 2025, 28(2): 306-309.

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腹腔镜与胆道镜双镜联合治疗复发性胆总管结石患者疗效研究^*

Laparoscopic cholecystectomy and choledochoscopy combination in the treatment of patients with recurrent common bile duct stones after biliary tract surgery

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