双镜联合手术治疗胆囊结石合并胆总管结石患者临床效果研究*

doi:10.3969/j.issn.1672-5069.2026.02.038

摘要/Abstract

摘要： 目的探讨腹腔镜胆囊切除术(LC)联合腹腔镜下胆总管探查(LCBDE)与内镜下逆行胰胆管造影(ERCP)取石后LC术治疗胆囊结石合并胆总管结石患者临床效果差异。方法 2022年3月～2025年6月我院诊治的89例胆囊结石合并胆总管结石患者,其中44例观察组接受LC联合LCBDE术治疗,另45例对照组接受ERCP后择期LC术治疗。采用视觉模拟评分法(VAS)评估疼痛,采用免疫比浊法检测血清C反应蛋白(CRP)水平。结果两组基线资料,包括年龄、性别、体质指数、胆总管直径、结石数量和血清胆红素水平比较,无显著性差异(P>0.05),具有可比性;观察组一次性结石清除率为97.7%,显著高于对照组的80.0%(P<0.05),而肠功能恢复和住院时间分别为(2.1±0.6)d和(7.2±1.8)d,均显著短于对照组【分别为(3.0±0.7)d和(10.4±2.3)d,P<0.05[;在术后48 h,观察组VAS评分为(2.3±0.8),显著小于对照组【(3.1±0.9),P<0.05[;在术后4 d,观察组血清CRP水平为(6.9±3.1)mg/L,显著低于对照组【(12.8±5.6)mg/L,P<0.05[;观察组术后并发症发生率为15.9%,显著低于对照组的40.0%(P<0.05)。结论 LC联合LCBDE或ERCP后择期行LC术均可以治疗胆囊结石合并胆总管结石患者,但患者病情和医生手术条件都可能影响治疗结果。临床需综合评估,选择应用。

关键词: 胆囊结石, 胆总管结石, 腹腔镜胆囊切除术, 腹腔镜下胆总管探查术, 内镜下逆行胰胆管造影术, 治疗

Abstract: Objective This study aimed to compare clinical efficacy and safety of Laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE), and selective LC after endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of patients with cholelithiasis and concomitant choledocholithiasis. Methods A total of 89 consecutive patients with cholelithiasis and concomitant choledocholithiasis were encountered in our hospital between May 2022 and June 2025, of them, 44 patients in observation group underwent LC and LCBDE, and 45 patients in control received selective LC after ERCP. Post-operational pain was evaluated by visual analogue scale (VAS), and serum C-reactive protein (CRP) level was routinely detected. Results Baseline clinical materials, including age, gender, body mass index, diameters of common bile ducts, numbers of stones and total serum bilirubin levels, between the two groups were comparable(P>0.05); one-time stone clearance rate in the observation group was 97.7%, much higher than 80.0%(P<0.05) in the control, and restoration of bowel function time and hospital stay were (2.1±0.6)d and (7.2±1.8)d, both much shorter than [(3.0±0.7)d and (10.4±2.3)d, respectively P<0.05] in the control; by 48 h after operation, VAS score in the observation was (2.3±0.8), much less than [(3.1±0.9), P<0.05] in the control, and by 4 days after surgery, serum CRP level was (6.9±3.1)mg/L, much lower than [(12.8±5.6)mg/L, P<0.05] in the control; incidence of post-operational complications was 15.9%, much lower than 40.0%(P<0.05) in the control group. Conclusion We believe that both LC and LCBDE, or LC after ERCP could be selected for dealing with patients with cholelithiasis and choledocholithiasis, which should be carried out depending on both patient’ condition and technical skills.

Key words: Cholelithiasis, Choledocholithiasis, Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration, Endoscopic retrograde cholangiopancreatography, Therapy

刘成宸, 颜勋, 张明, 陆峰. 双镜联合手术治疗胆囊结石合并胆总管结石患者临床效果研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 313-316.

Liu Chengchen, Yan Xun, Zhang Ming, et al. Clinical efficacy and safety of dual-endoscopic surgery in the minimally invasive treatment of patients with cholelithiasis and concomitant choledocholithiasis[J]. Journal of Practical Hepatology, 2026, 29(2): 313-316.

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双镜联合手术治疗胆囊结石合并胆总管结石患者临床效果研究^*

Clinical efficacy and safety of dual-endoscopic surgery in the minimally invasive treatment of patients with cholelithiasis and concomitant choledocholithiasis

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