内镜逆行胰胆管造影术与腹腔镜胆总管切开探查术治疗胆囊切除术后胆总管结石患者效果比较*

doi:10.3969/j.issn.1672-5069.2025.03.037

摘要/Abstract

摘要： 目的比较内镜逆行胰胆管造影术(ERCP)与腹腔镜胆总管切开探查术(LCE)治疗胆总管结石患者的效果。方法 2020年2月～2022年2月我院收治的60例胆总管结石患者,纳入患者均为胆囊切除术后患者。随机将患者分为观察组30例和对照组30例,分别接受LCE或ERCP术治疗。采用化学发光法检测血清C肽水平,采用ELISA法检测血清皮质醇和去甲肾上腺素(NE),采用磁粉化学发光法检测血清促肾上腺皮质激素(ACTH)水平。结果观察组手术成功率和结石清除率分别为96.7%和93.3%,均显著高于对照组(分别为66.7%和66.7%,P<0.05);观察组手术时间和手术花费分别为(62.4±6.5)min和(2.4±0.5)万元,均显著短于或低于对照组【分别为(106.3±8.7)min和(3.0±0.8)万元,P<0.05】,而肛门排气、下床活动时间和住院日显著长于对照组(P<0.05);在术后5 d,观察组血清皮质醇和去甲肾上腺素水平分别为(211.2±32.1)nmoL/mL和(5.0±0.6)nmoL/mL,显著高于对照组【分别为(152.1±41.2)nmoL/mL和(3.1±0.8)nmoL/mL, P<0.05】;术后,两组胆瘘、腹腔感染、胆管炎、胆道出血和胰腺炎等并发症发生率无显著性差异(20.0%对16.7%,P>0.05)。结论采用LCE手术治疗胆总管结石患者手术完成率和结石清除率高,临床疗效好。

关键词: 胆总管结石, 腹腔镜胆总管切开探查术, 内镜逆行胰胆管造影术, 治疗

Abstract: Objective The aim of this study was to compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic choledochotomy and exploration (LCE) in the treatment of patients with post-cholecystectomy choledocholithiasis. Methods Sixty patients with choledochal stones who had cholecystectomy were recruited in our hospital between February 2020 and February 2022, and we randomly assigned patients to receive LCE (observation, n=30) or ERCP (control, n=30). Serum C-peptide, cortisol (Cor), norepinephrine (Ne) and adrenocorticotrophic hormone (ACTH) levels were determined. Results The surgical successful rate and stone clearance rate in the observation group were 96.7% and 93.3%, both significantly higher than66.7% and 66.7% (P<0.05) in the control group; the operational time and medical cost in the observation group were (62.4±6.5)min and (20000.4±5000.0)yuan RMB, both much shorter or less than(106.3±8.7)min and (30000.0±8000.0)yuan RMB, P<0.05], while postoperative exhaustion time, ambulation time and hospital stay were much longer than in the control(P<0.05); five days after operation, serum Cor and Ne levels in the observation were (211.2±32.1)nmoL/mL and (5.0±0.6)nmoL/mL, significantly higher than [(152.1±41.2)nmoL/mL and (3.1±0.8)nmoL/mL, respectively, P<0.05] in the control; there were no significant differences in post-operational complications, such as bile leakage, infection, bleeding and pancreatitis between the two groups (20.0% vs. 16.7%, P>0.05). Conclusion The surgery by LCE in dealing with patients with choledocholithiasis who have gall bladder removed is promising, with high surgery success and stone clearance.

Key words: Choledocholithiasis, Laparoscopic choledochotomy and exploration, Endoscopic retrograde cholangiopancreatography, Therapy

柯俊杰, 邢杰宇, 张明英. 内镜逆行胰胆管造影术与腹腔镜胆总管切开探查术治疗胆囊切除术后胆总管结石患者效果比较^*[J]. 实用肝脏病杂志, 2025, 28(3): 466-469.

Ke Junjie, Xing Jieyu, Zhang Mingying. Comparison of endoscopic retrograde cholangiopancreatography and laparoscopic choledochotomy and exploration in the treatment of patients with post-cholecystectomy choledocholithiasis[J]. Journal of Practical Hepatology, 2025, 28(3): 466-469.

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内镜逆行胰胆管造影术与腹腔镜胆总管切开探查术治疗胆囊切除术后胆总管结石患者效果比较^*

Comparison of endoscopic retrograde cholangiopancreatography and laparoscopic choledochotomy and exploration in the treatment of patients with post-cholecystectomy choledocholithiasis

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