腹腔镜胆囊切除术联合内镜下逆行胰胆管造影和十二指肠乳头括约肌切开术治疗胆囊结石合并肝外胆管结石患者疗效研究*

doi:10.3969/j.issn.1672-5069.2021.05.037

摘要/Abstract

摘要： 目的探讨采用腹腔镜胆囊切除术(LC)、内镜下逆行胰胆管造影(ERCP)和十二指肠乳头括约肌切开术(EST)联合治疗胆囊结石合并肝外胆管结石患者的疗效。方法 2018年1月～2020年10月我院治疗的胆囊结石合并肝外胆管结石88例,在47例观察组采用LC联合ERCP和EST手术,在41例对照组采用开腹胆囊切除和胆总管探查取石治疗。采用视觉模拟评分法(VAS)评价术后疼痛程度。结果两组结石一次性清除率比较无显著性差异(93.6%对95.1%,P>0.05);观察组术中出血量为(28.1±6.2)ml,显著少于对照组【(43.9±7.5)ml,P<0.05】,手术时间、术后禁食时间和住院时间分别为(105.7±25.5)min、(2.2±0.4)d和(7.6±1.0)d,显著短于对照组【分别为(130.2±26.7)min、(3.0±0.6)d和(12.7±1.3)d,P<0.05】;术后48 h和72 h VAS评分分别为(3.7±0.6)分和(2.5±0.5)分,均显著低于对照组【分别为(4.0±0.7)分和(2.9±0.5)分,P<0.05】;术后7 d,观察组血清ALT和AST水平分别为(46.1±5.6)U/L和(42.5±5.2)U/L,显著低于对照组【分别为(59.8±5.4)U/L和(64.7±5.1)U/L,P<0.05】,而血脂肪酶水平为(808.2±105.7)U/L,显著高于对照组【(721.9±103.0)U/L,P<0.05】;术后观察组并发症发生率为4.3%,显著低于对照组的14.1%(P<0.05)。结论采用LC联合ERCP和EST治疗胆囊结石合并肝外胆管结石患者可促进术后恢复,改善肝功能,减少并发症的发生。

关键词: 胆囊结石, 肝外胆管结石, 腹腔镜胆囊切除术, 内镜下逆行胰胆管造影, 十二指肠乳头括约肌切开术, 治疗

Abstract: Objective The aim of this study was to investigate the outcomes of laparoscopic cholecystectomy (LC) and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) in treatment of patients with gallbladder and extrahepatic bile duct stones. Methods A total of 88 patients with gallbladder stones and extrahepatic bile duct stones were admitted to our hospital between January 2018 and October 2020, and were divided into observation group receiving LC and EST combination surgery in 47 cases and control group receiving open cholecystectomy and laparoscopic common bile duct exploration. The visual analogue scales (VAS ) was applied to evaluate the post-operational pain. Results The one-time radical stone removals in the two groups were 93.6% vs. 95.1% (P>0.05); in the observation group, the intraoperative blood loss was (28.1±6.2)ml, significantly less than ,and the operation time, postoperative fasting time and hospital stay were(105.7±25.5)min, (2.2±0.4)d and (7.6±1.0)d, all significantly shorter than in the control; at 48 and 72 hours, the VAS scores in the observation group were (3.7±0.6) and (2.5±0.5), both significantly lower than in the control; 7 days after operation, serum ALT and AST levels in the observation were (46.1±5.6)U/L and (42.5±5.2)U/L, both significantly lower than , while blood lipase level was (808.2±105.7)U/L, significantly higher than in the control; the incidence of post-operational complications in observation group was much lower than that in the control group (4.3% vs. 14.1%, P<0.05). Conclusion The combination of LC and EST under ERCP might have a good outcomes in patients with gallbladder stones and extrahepatic bile duct stones, which could promote postoperative recovery, and less postoperative complications.

Key words: Cholelithiasis, Laparoscopic cholecystectomy, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Therapy

刘小飞, 张大伟, 罗宏宇, 李国权, 张静宜. 腹腔镜胆囊切除术联合内镜下逆行胰胆管造影和十二指肠乳头括约肌切开术治疗胆囊结石合并肝外胆管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2021, 24(5): 753-756.

Liu Xiaofei, Zhang Dawei, Luo Hongyu, et al. Outcomes of laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy in treatment of patients with gallbladder and extrahepatic bile duct stones[J]. Journal of Practical Hepatology, 2021, 24(5): 753-756.

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腹腔镜胆囊切除术联合内镜下逆行胰胆管造影和十二指肠乳头括约肌切开术治疗胆囊结石合并肝外胆管结石患者疗效研究^*

Outcomes of laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy in treatment of patients with gallbladder and extrahepatic bile duct stones

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