LC+ERCP+EST治疗胆囊结石合并胆总管结石疗效分析  

Effect of LC+ERCP+EST on patients with gallstone and choledocholithiasis

作　　者：薛广钱[1] 汪海[1] 王怀志[1] XUE Guang-qian;WANG Hal;WANG Huai- zhi.(Department of General Surgery, Armed Police Corps Hospital of Henan, Zhertzhou 453000, Chin)

机构地区：[1]武警河南总队医院普外科,郑州453000

出　　处：《肝胆外科杂志》2018年第3期198-201,共4页Journal of Hepatobiliary Surgery

摘　　要：目的研究腹腔镜胆囊切除术(LC)+经内镜逆行性胰胆管造影术(ERCP)+内镜下十二指肠乳头括约肌切开术(EST)治疗对胆囊结石合并胆总管结石患者围术期指标、胃肠功能恢复及术后并发症的影响。方法收集我院2010年1月至2016年12月300例胆囊结石合并胆总管结石患者病历资料。我院自2014年1月开展LC+ERCP+EST,将2010年1月至2013年12月133例接受传统开腹胆囊切除术+胆总管切开探查术+T管引流术治疗的患者纳入开腹组,将2014年1月至2016年12月167例接受LC+ERCP+EST治疗的患者纳入腹腔镜组。比较两组围手术期指标及胃肠功能恢复时间,检测患者肝功能,统计术后并发症发生率。结果腹腔镜组手术时间为(136.12±29.94)min显著长于开腹组的(105.38±23.17)min(P<0.05),术中出血量、肠鸣音恢复时间、肛门排气时间、住院时间分别为(28.75±6.33)ml、(9.40±2.07)h、(20.56±4.52)h、(11.08±2.46)d显著短于开腹组的(74.23±16.30)ml、(18.55±4.11)h、(36.02±7.94)h、(15.29±3.36)d(P<0.05)。腹腔镜组术后并发症总发生率为7.7%显著低于开腹组的15.8%(P>0.05)。结论 LC+ERCP+EST治疗胆囊结石合并胆总管结石,可以减少术中出血量,缩短胃肠道功能恢复时间,降低并发症发生率,有利于患者术后恢复。Objective To study the effect of laparoscopic cholecystectomy （LC） combined with endoscopic retrograde cholangiopancreatography （ERCP） and endoscopic sphincterotomy （EST） on perioperative indexes, gastrointestinal function recovery and postoperative complications in patients with gallstone and choledocholithiasis. Methods The clinical data of 300 patients with gallstone and choledocholitiliasis who were admitted to the hospital from January 2010 to December 2016 were collected. LC ± ERCP ± EST was carried out in the hospital since January 2014. 133 patients treated by traditional open cholecystectomy combined with choledochotomy with exploration and T tube drainage during January 2010-December 2013 were included in the open group, while 167 patients treated by LC ± ERCP ± EST during January 2014-December 2016 were included in the laparoscopic group. The perioperative indexes and the recovery time of gastrointestinal function were compared between the two groups. The liver function of patients was detected and the incidence rate of postoperative complications was statistically analyzed. Results The operative time of laparoscopic group [ （ 136. 12 ± 29. 94） min] was significantly longer than that of open group [ （ 105. 38 ± 23.17） min] （P 〈 0. 05 ）, while the intraoperative blood loss, recovery time of bowel sound, anal exhaust time and hospitalization time [ （28.75 ± 6. 33 ） ml, （9.40 ± 2. 07） h, （20. 56 ± 4. 52） h, （ 11.08 ±2.46） d] were significantly less / shorter than those of the open group [ （74.23 ± 16. 30） ml, （ 18.55 ±4. 11 ） h, （36. 02 ± 7. 94） h, （ 15. 29 ± 3.36） d ] （P 〈 0. 05）. The total incidence of postoperative complications in the laparoscopic group was significantly lower than that in the open group （7.7% vs 15.8% ） （ P 〉 0. 05 ）. Conclusion The application of LC ± ERCP ± EST in the treatment of gallstone with choledocholithiasis can reduce the intraoperative blood loss, shorten the recovery time of gastroin

关 键 词：胆囊结石 胆总管结石 腹腔镜胆囊切除术 经内镜逆行性胰胆管造影术 内镜下十二指肠乳头括约肌切开术 胃肠功能 

分 类 号：R657.4[医药卫生—外科学]