摘要
目的 探讨腹腔镜胆总管探查术(LCBDE)+腹腔镜胆囊切除术(LC)一步法治疗高位胆囊结石合并胆总管结石的疗效,并分析术后并发症.方法 选取2019年2月~2023年4月在我院诊治的高位胆囊结石合并胆总管结石患者80例,随机分为2组,对照组40例和研究组40例,对照组内镜逆行胰胆管造影(ERCP)/内镜十二指肠乳头括约肌切开术(EST)+LC序贯二步法治疗,研究组给予LCBDE+LC 一步法治疗,比较两组围术期相关指标、胆总管结石清除和复发情况,术前、术后5d的炎症因子、肝功能指标,临床治疗疗效和并发症发生情况.结果 研究组手术时间、肛门排气时间、住院时间与对照组比较,明显较短(P<0.05),研究组术中出血量、住院费用与对照组比较,明显较少(P<0.05),研究组胆总管结石清除率、复发率与对照组比较,均无统计学意义(P>0.05).术后5d,两组TNF-α、IL-6、WBC、NEUT较术前均升高(P<0.05),但研究组与对照组比较,明显较低(P<0.05).术后5d,两组TBIL、ALB、ALT、GGT较术前均降低(P<0.05),且研究组与对照组比较,明显较低(P<0.05).研究组手术成功率与对照组比较,无统计学意义(P>0.05).研究组并发症发生率与对照组比较,明显较低(P<0.05).结论 与ERCP/EST+LC序贯二步法相比较,LCBDE+LC 一步法治疗高位胆囊结石合并胆总管结石在胆总管结石清除、手术成功方面无明显差异,但可更有效减轻炎症,改善肝功能,降低并发症,促进患者更快康复.
Objective To investigate the efficacy of laparoscopic choledocholithiasis(LCBDE)plus laparoscopic cholecystec-tomy(LC)in the treatment of high neck cholecystolithiasis combined with choledocholithiasis,and to analyze the postoperative compli-cations.Methods A total of 80 patients with high neck cholecystolithiasis combined with choledocholithiasis treated in our hospital from February 2019 to April 2023 were randomly divided into 2 groups,40 cases in the control group and 40 cases in the study group.The control group was treated with endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic duodenal papillary sphincterot-omy(EST)+LC sequential two-step method.The study group was given one-step treatment with LCBDE+LC.The perioperative in-dexes,clearance and recurrence of choledocholithiasis,preoperative and postoperative inflammatory factors,liver function indexes,clinical therapeutic efficacy and complications were compared between the two groups.Results The operation time,anal exhaust time and hospital stay of the study group were significantly shorter than those of the control group(P<0.05),the intraoperative blood loss and hospital expenses of the study group were significantly less than those of the control group(P<0.05),and there was no statistical significance in the clearance rate and recurrence rate of common bile duct stones in the study group compared with the control group(P>0.05).On the 5 th day after operation,TNF-α,IL-6,WBC and NEUT in both groups were higher than those before operation(P<0.05),but they were significantly lower in the study group than in the control group(P<0.05).5 days after surgery,TBIL,ALB,ALT and GGT in both groups were lower than those before surgery(P<0.05),and the study group was significantly lower than the con-trol group(P<0.05).The success rate of operation in the study group was not statistically significant compared with the control group(P>0.05).The complication rate of the study group was significantly lower than that of the control group(P<0.05).Conclusion Compared with ERCP/EST+LC sequential two-step method,LCBDE+LC one-step method for the treatment of high neck cholecystolithi-asis combined with choledocholithiasis has no significant difference in the removal of choledocholithiasis and the success of surgery,but it can more effectively reduce inflammation,improve liver function,reduce complications and promote faster recovery of patients.
作者
芮道喜
汪永贵
杨军
王健
苏杰
RUI Dao-xi;WANG Yong-gui;YANG jun(The Wanzhi Hospital of Wuhu,Wuhu241100,China)
出处
《肝胆外科杂志》
2023年第6期448-452,共5页
Journal of Hepatobiliary Surgery
关键词
胆囊结石
胆总管结石
腹腔镜胆总管探查术
腹腔镜胆囊切除术
一步法
gallstone
choledocholithiasis
laparoscopic common bile duct exploration
laparoscopic cholecystectomy
one-stepprocess
