ERCP/EST联合LC治疗胆总管结石伴急性胆管炎患者疗效研究*

doi:10.3969/j.issn.1672-5069.2026.04.037

摘要/Abstract

摘要： 目的探讨内镜下逆行胰胆管造影术(ERCP)/内镜括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)治疗胆总管结石(CBDS)伴急性胆管炎患者的疗效。方法 2023年1月~2025年5月我院收治的CBDS伴急性胆管炎患者118例,其中67例观察组患者在入院后行ERCP/EST联合LC治疗,另51例对照组患者入院后行腹腔镜胆总管探查术(LCBDE)联合LC术治疗。随访3个月。结果观察组术中出血量和术后排气时间分别为(52.3±3.5)mL和(32.6±2.1)h,均显著少于或短于对照组[分别为(58.7±4.9)mL和(35.3±2.6)h,P＜0.05],而手术总时间、住院时间和住院费分别为(2.9±0.6)h、(10.7±1.6)d和(2.2±0.4)万元,均显著长于或多于对照组[分别为(2.1±0.4)h、(6.6±1.2)d和(1.8±0.3)万元,P＜0.05];在术后5 d,观察组血清ALT、AST和GGT水平分别为(46.5±5.1)U/L、(41.2±5.0)U/L和(92.8±8.6)U/L,均显著低于对照组[分别为(58.6±6.7)U/L、(55.2±6.2)U/L和(115.4±10.5)U/L,P＜0.05];术后观察组并发症发生率为10.5%,与对照组的11.8%比,差异无统计学意义(P＞0.05);观察组结石清除率为97.0%,与对照组的96.1%比,差异无统计学意义(P＞0.05)。结论 ERCP/EST联合LC术和LCBDE)联合LC术均可应用于治疗CBDS伴急性胆管炎患者,可根据医院技术水平和患者基本情况选择实施。

关键词: 胆总管结石, 急性胆管炎, 内镜下逆行胰胆管造影术, 内镜括约肌切开术, 腹腔镜胆总管探查术, 腹腔镜胆囊切除术, 治疗

Abstract: Objective The aim of this study was to investigate endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) in combination with laparoscopic cholecystectomy (LC) in treatment of patients with common bile duct stones (CBDS) and acute cholangitis (AC). Methods A total of 118 patients with CBDS and AC were encountered in our hospital between January 2023 and May 2025, and of them, 67 patients in the observation group underwent ERCP/EST and LC, and another 51 patients in the control group received laparoscopic common bile duct exploration (LCBDE) and LC. All patients were followed-up for three months. Results Intraoperative blood loss and postoperative exhaust time in the observation group were (52.3±3.5)mL and (32.6±2.1)h, both significantly less or shorter than [(58.7±4.9)mL and (35.3±2.6)h, respectively, P＜0.05],while total operation time, hospital stay and medical cost were (2.9±0.6)h, (10.7±1.6)d and (22.0±4.0)thousand yuan, all significantly longer or much more than [(2.1±0.4)h, (6.6±1.2)d and (18.0±3.0)thousand yuan,respectively, P＜0.05] in the control;by day five after operation, serum ALT, AST and GGT levels in the observation group were (46.5±5.1)U/L, (41.2±5.0)U/L and (92.8±8.6)U/L, all much lower than [(58.6±6.7)U/L, (55.2±6.2)U/L and (115.4±10.5)U/L,respectively, P＜0.05] in the control;post-operationally, incidence of complications in the observation group was 10.5%, not significantly different compared to 11.8% in the control (P＞0.05);there was no significant difference as respect to stone clearance rate between the two groups (97.0% vs. 96.1%, P>0.05). Conclusion Both ERCP/EST combined with LC or LCBDE and LC could be performed in dealing with patients with CBDS and AC, and the choice might depend on surgeons skills and patients’ conditions.

Key words: Common bile duct stone, Acute cholangitis, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Laparoscopic common bile duct exploration, Laparoscopic cholecystectomy, Therapy

王蒲雄志, 孙运坡, 于嵩, 杨开, 袁周. ERCP/EST联合LC治疗胆总管结石伴急性胆管炎患者疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(4): 625-628.

Wang Puxiongzhi, Sun Yunpo, Yu Song, et al. ERCP/EST in combination with LC in the treatment of patients with common bile duct stones and acute cholangitis[J]. Journal of Practical Hepatology, 2026, 29(4): 625-628.

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ERCP/EST联合LC治疗胆总管结石伴急性胆管炎患者疗效研究^*

ERCP/EST in combination with LC in the treatment of patients with common bile duct stones and acute cholangitis

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