腹腔镜胆总管探查术联合腹腔镜胆囊切除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.1672-5069.2021.04.034

摘要/Abstract

摘要： 目的探讨采用腹腔镜胆总管探查术(LCBDE)联合腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石患者的临床疗效。方法 2016年5月～2020年7月我院诊治的85例胆囊结石合并胆总管结石患者,其中41例接受LCBDE联合LC术,另44例接受在ERCP下行十二指肠镜Oddi括约肌切开术(EST)联合LC术治疗,术后随访1年。采用视觉模拟评分法(VAS)评估疼痛,使用流式细胞仪检测外周血淋巴细胞亚群。结果两组手术成功率和结石残留率比较,均无显著性差异(分别为97.6%对93.2%和2.4% 对6.8%,P>0.05),观察组结石复发率为2.4%,镇痛泵使用率为36.6%,VAS评分为(2.5±0.5),均显著低于对照组【分别为15.9%、59.1%和(3.1±0.6),P<0.05);在术后2周,两组血生化指标比较,无显著性差异(P>0.05);观察组外周血CD3⁺、CD4⁺和CD8⁺细胞百分比及D4⁺/CD8⁺比值分别为(52.8±7.1)%、(40.3±7.5)%、(21.0±5.2)%和(1.9±0.3),与对照组的(54.7±6.9)%、(41.0±7.2)%、(22.5±5.6)%和(1.8±0.3)比,显著无统计学意义(P>0.05);两组术后并发症发生率也无显著性差异(2.4%对9.1%,P>0.05)。结论采取LCBDE联合LC术治疗胆囊结石合并胆总管结石患者手术成功率较高,能减轻术后疼痛,仍为治疗这类疾病的良好方法。

关键词: 胆石症, 腹腔镜胆囊切除术, 腹腔镜胆总管探查术, 治疗

Abstract: Objective The aim of this study was to explore the clinical efficacy of laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) combination in the treatment of patients with cholecystolithiasis and choledocholithiasis. Methods A total of 85 patients with cholecystolithiasis and choledocholithiasis were enrolled in this study between May 2016 and July 2020, 41 patients received LCBDE and LC combination, and another 44 patients received endoscopic sphincterotony (EST) under endoscopic retrograde cholangiopancreatography (ERCP) and LC. All patients were followed-up for 12 months. The visual analogue scales (VAS) score was applied to evaluate post-operational pain, and peripheral blood lymphocyte subsets was assayed by FCM. Results There were no significant differences respect to the surgical success rates and stone residual rates between the two groups (97.6% vs.93.2% and 2.4% vs. 6.8%, P>0.05), the usage rate of analgesic pumps and VAS score were 36.6% and (2.5±0.5), both significantly lower than 59.1% and (3.1±0.6) in the control (P<0.05), and the stone recurrence rate as confirmed by sonography one year after operation in the observation group was 2.4%,significantly lower than 15.9% in the control (P<0.05); there were no significant differences respect to biochemical parameters between the two groups two weeks after operation (P>0.05); the percentages of peripheral blood CD3⁺, CD4⁺ and CD8⁺ cells as well as the ratio of D4⁺/CD8⁺ cells in the observation group were (52.8±7.1)%, (40.3±7.5)%, (21.0±5.2)% and (1.9±0.3), not significantly different as compared to [(54.7±6.9)%, (41.0±7.2)%, (22.5±5.6)% and (1.8±0.3), respectively, P>0.05] in the control; there was no significant difference in the incidence of post-operational complications between the two groups (2.4% vs. 9.1%, P>0.05). Conclusion The surgical success rate of LCBDE and LC combination in the treatment of patients with cholecystolithiasis and choledocholithiasis is high, and is still a good approach for the management of patients with this kind of entity.

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

付前广, 李倩, 冯小雪, 王勇, 邓如兵, 崔畅. 腹腔镜胆总管探查术联合腹腔镜胆囊切除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, 2021, 24(4): 589-592.

Fu Qianguang, Li Qian, Feng Xiaoxue, et al. Clinical efficacy of laparoscopic common bile duct exploration and laparoscopic cholecystectomy combination in the treatment of patients with cholecystolithiasis and choledocholithiasis[J]. Journal of Practical Hepatology, 2021, 24(4): 589-592.

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腹腔镜胆总管探查术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石患者临床疗效研究^*

Clinical efficacy of laparoscopic common bile duct exploration and laparoscopic cholecystectomy combination in the treatment of patients with cholecystolithiasis and choledocholithiasis

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