LC联合ERCP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.1672-5069.2023.01.034

Abstract

Abstract: Objective The aim of this study was to summarize the clinical efficacy of laparoscopic cholecystectomy (LC) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of patients with gallbladder and extrahepatic bile duct stones. Methods 142 patients with gallbladder and extrahepatic bile duct stones were encountered in our hospital between March 2018 and March 2022, and 71 patients in control group were treated with traditional open laparotomy, and another 71 patients in observation group were treated with ERCP and thereafter LC. Serum C-reactive protein (CRP) level was detected by immunoturbidimetry, and serum procalcitonin (PCT) level was detected by solid-phase immunochromatography. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were assayed by double-antibody one-step sandwich method. Results The surgical time, intraoperative blood loss, the visual analogue scale score and hospital stay in the observation group were (92.3±8.7)min, (47.9±5.2)mL, (3.8±0.4) and (5.2±2.3)d, significantly shorter or less than [(116.4±10.2)min, (76.5±6.4)mL, (4.1±0.5) and (7.1±2.6) d, respectively, P<0.05], while the medical cost was (34000.0±4000.0) yuan, much higher than [(27000.0±3000.0) yuan,P<0.05] in the control; three days after operation, serum CRP, IL-6 and TNF-α levels in the observation were (48.4±2.9)mg/L, (9.7±1.2)ng/L and (1.3±0.2)ng/L, significantly lower than [(61.7±3.1)mg/L, (14.3±1.6)ng/L and (2.4±0.2)ng/L, respectively, P<0.05] in the control; the incidence of post-operationally complications, such as acute pancreatitis, bleeding, infection and bile leak, in the observation was 11.3%, much lower than 23.9%(P<0.05) in the control group. Conclusion The application of ERCP and thereafter LC combination in the treatment of patients with gallbladder and extrahepatic bile duct stones could effectively improve the surgical-related indicators, ensure the stone clearance and promote the postoperative recovery, which might be related to a relatively low systemic inflammatory reactions.

Key words: Gallbladder stones, Extrahepatic bile duct stones, Laparoscopic cholecystectomy, Endoscopic retrograde cholangiopancreatography, Therapy

Liu Songhang, Gao Youkui, Cao Liangqi. Clinical efficacy of LC and ERCP in the treatment of patients with gallbladder and extrahepatic bile duct stones[J]. Journal of Practical Hepatology, 2023, 26(1): 132-135.

References

[1] Parra-Membrives P, Martínez-Baena D, Lorente-Herce JM,et al. Choledocholithiasis recurrence following laparoscopic common bile duct exploration. Cir Esp (Engl Ed), 2019,97(6):336-342.
[2] Fang L, Huang J, Zheng H,et al. Laparoscopic transcystic common bile duct exploration in patients with a nondilated common bile duct. Ann Palliat Med, 2021,10(12):12845-12856.
[3] Zhang Z, Liu Z, Liu L,et al. Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones. Front Med, 2017,11(4):576-589.
[4] Clout M, Blazeby J, Rogers C,et al. Randomised controlled trial to establish the clinical and cost-effectiveness of expectant management versus preoperative imaging with magnetic resonance cholangiopancreatography in patients with symptomatic gallbladder disease undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones (The Sunflower Study): a study protocol. BMJ Open, 2021,11(6):e044281.
[5] 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2011年版). 中华消化外科杂志,2011,10(1):9-13.
[6] Zajkowska M, Kulczyńska-Przybik A, Dulewicz M,et al. Eotaxins and their receptor as biomarkers of colorectal cancer. J Clin Med, 2021,10(12):2675.
[7] Serebrennikova KV, Samsonova JV, Osipov AP. A semi-quantitative rapid multi-range gradient lateral flow immunoassay for procalcitonin. Mikrochim Acta, 2019,186(7):423.
[8] Hughes SF, Jones N, Thomas-Wright SJ,et al. Shock wave lithotripsy, for the treatment of kidney stones, results in changes to routine blood tests and novel biomarkers: a prospective clinical pilot-study. Eur J Med Res, 2020,25(1):18.
[9] Xia H, Xin X, Yang T,et al. Surgical strategy for recurrent common bile duct stones: a 10-year experience of a single center. Updates Surg, 2021,73(4):1399-1406.
[10] Medhioub M, Khsiba A, Mahmoudi M,et al. Preoperative endoscopic treatment for the management of concomitant gallstones and common bile duct stones. Tunis Med, 2021,99(2):233-237.
[11] 王云峰,徐斌,王杰,等. 腹腔镜、胆道镜及十二指肠镜联合免T管引流对胆囊结石合并胆总管结石的治疗效果分析. 临床肝胆病杂志,2021,37(4):872-876.
[12] Lyu Y, Cheng Y, Li T,et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc, 2019,33(10):3275-3286.
[13] 周新锋,夏卿,李祥,等. 腹腔镜胆囊切除术治疗急性结石性胆囊炎合并胆汁性腹膜炎的效果分析. 中华医院感染学杂志,2017,27(24):5615-5617,5625.
[14] Li KY, Shi CX, Tang KL,et al. Advantages of laparoscopic common bile duct exploration in common bile duct stones. Wien Klin Wochenschr, 2018,130(3-4):100-104.
[15] Li G, Pang Q, Zhai H,et al. Spy glass-guided laser lithotripsy versus laparoscopic common bile duct exploration for large common bile duct stones: a non-inferiority trial. Surg Endosc, 2021,35(7):3723-3731.
[16] 刘小飞,张大伟,罗宏宇,等. 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. 实用肝脏病杂志,2021,24(5):753-756.
[17] Huber W, Algül H, Lahmer T,et al. Pancreatitis cytosorbents (CytoSorb) inflammatory cytokine removal: A prospective study (PACIFIC). Medicine (Baltimore), 2019,98(4):e13044.
[18] Matsumura T, Komatsu S, Komaya K,et al. Dual common bile duct examination with transcystic choledochoscopy and cholangiography in laparoscopic cholecystectomy for suspected choledocholithiasis: a prospective study. Surg Endosc, 2021,35(7):3379-3386.
[19] 侯潇峰,宋展,刘驰,等. 同期腹腔镜胆囊切除术联合内镜下逆行胰胆管造影治疗胆囊结石合并胆总管结石临床分析. 中华实用诊断与治疗杂志,2021,35(2):156-158.
[20] Pencovich N, Lachiani M, Phillips A,et al. Serum amylase levels is a predictor for negative endoscopic retrograde cholangiopancreatography for suspected common bile duct stones. Surg Laparosc Endosc Percutan Tech, 2021,31(5):528-532.
[21] 陈永艺,陈华福,錡和强,等. ERCP/EST-LC治疗胆囊结石合并胆总管结石临床疗效及并发症. 现代生物医学进展,2021,21(5):867-870.

Clinical efficacy of LC and ERCP in the treatment of patients with gallbladder and extrahepatic bile duct stones

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