LCBDE与EST联合LC治疗胆囊结石合并胆总管结石患者疗效及安全性分析*

doi:10.3969/j.issn.1672-5069.2022.01.030

摘要/Abstract

摘要： 目的比较腹腔镜胆总管探查术(LCBDE)与内镜下括约肌切开术(EST)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疗效及安全性。方法 2017年4月～2020年4月我院收治的150例胆囊结石合并胆总管结石患者,其中77例接受LCBDE联合LC治疗,另73例接受EST联合LC治疗,术后随访12个月。采用ELISA法检测血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)。结果观察组手术时间和术中出血量分别为(143.3±17.7)min和(24.3±13.0)mL,显著长于或多于对照组【分别为(96.7±10.8)min和(16.7±7.2)mL,P＜0.05】,术后住院天数和住院费用分别为(6.2±1.3)d和(3.2±1.0)万元,均显著少于或短于对照组【分别为(7.1±1.5)d和(4.3±1.1)万元,P＜0.05】;在术后5 d,观察组血清IL-6水平和外周血WBC计数分别为(27.7±6.2)μg/L和(9.1±1.1)×10⁹/L,显著低于对照组【分别为(30.5±7.7)μg/L和(10.5±1.6)×10⁹/L,P＜0.05】;术后3个月行超声检查,发现两组均无结石残留,随访12个月,观察组结石复发率为7.8%,与对照组的11.0%比,无显著性差异(P＞0.05);术后2周,观察组胆瘘发生率为10.4%,显著高于对照组的1.4%(P＜0.05),而胰腺炎和高淀粉酶血症发生率为2.6%和1.3%,显著低于对照组(分别为13.7%和16.4%,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可能更有利于缩短患者住院时间,节省医疗费用,但两种手术方法清除结石的效果相似,临床可根据实际情况作出适当的选择。

关键词: 胆囊结石, 胆总管结石, 腹腔镜胆囊切除术, 胆总管探查术, 内镜下括约肌切开术, 治疗

Abstract: Objective The aim of this study was to compare the efficacy and safety of laparoscopic common bile duct exploration (LCBDE) or endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC) combination in the treatment of patients with gallbladder stone and choledocholithiasis. Methods 150 patients with gallbladder stones and choledocholithiasis were admitted to our hospital between April 2017 and April 2020, and 77 patients in observation group underwent LCBDE and LC, and 73 patients in control underwent EST and LC combination surgery. They were followed-up for 12 months after surgery. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA. Results The operation time and intraoperative blood loss in observation group were (143.3±17.7) min and (24.3±13.0) mL, significantly longer or much more than [(96.7±10.8) min and (16.7±7.2) mL, P<0.05], the postoperative hospitalization stay and medical cost were (6.2±1.3) d and (3.2±1.0) ten thousands yuan, significantly shorter or less or than [(7.1±1.5) d and (4.3±1.1) ten thousands yuan, P<0.05] in the control; at day five after surgery, serum IL-6 level and peripheral white blood cell count were (27.7±6.2) μg/L and (9.1±1.1)×10⁹/L, significantly lower than [(30.5±7.7) μg/L and (10.5±1.6)×10⁹/L, P<0.05] in the control group; no stone residual in the two groups was found by sonography three months after surgery, and at 12 months of follow-up, the stone recurrence in the observation was 7.8%, not significantly different compared to 11.0% in the control (P＞0.05); two weeks after surgery, the incidence of bile fistula in the observation was 10.4%, significantly higher than 1.4%(P＜0.05), while the incidences of pancreatitis and hyperamylasemia were 2.6% and 1.3%, significantly lower than 13.7% and 16.4% (P＜0.05) in the control. Conclusion The application of LCBDE and LC combination in the treatment of patients with gallbladder stone and choledocholithiasis could shorten hospitalization stay and reduce medical cost, while the stone clearance by the two surgical methods is similar, and the appropriate surgical choice could be made by clinicians.

Key words: Gallbladder stone, Choledocholithiasis, Laparoscopic cholecystectomy, Common bile duct exploration, Endoscopic sphincterotomy, Therapy

冯浩, 李顺宗, 王子伟. LCBDE与EST联合LC治疗胆囊结石合并胆总管结石患者疗效及安全性分析^*[J]. 实用肝脏病杂志, 2022, 25(1): 120-123.

Feng Hao, Li Shunzong, Wang Ziwei. Efficacy and safety of LCBDE or EST and LC combination in the treatment of patients with gallbladder stone and choledocholithiasis[J]. Journal of Practical Hepatology, 2022, 25(1): 120-123.

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LCBDE与EST联合LC治疗胆囊结石合并胆总管结石患者疗效及安全性分析^*

Efficacy and safety of LCBDE or EST and LC combination in the treatment of patients with gallbladder stone and choledocholithiasis

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