ERAS理念下三种微创术式治疗胆囊结石并胆总管结石的临床比较分析  

Comparative clinical analysis of three minimally invasive surgical procedures for cholecystolithiasis complicated with choledocholithiasis under ERAS concept

作　　者：叶赛 朱运海[1] 赵杰[1] 李威威 祝涵 蔡锋[1] Ye Sai;Zhu Yunhai;Zhao Jie;Li Weiwei;ZhuHan;Cai Feng(Department of gastrointestinal and hepatobiliary surgery,Shangqiu first people's hospital,Shangqiu,Henan,476100,China.)

机构地区：[1]商丘市第一人民医院胃肠肝胆外科,河南商丘476100

出　　处：《齐齐哈尔医学院学报》2022年第2期143-147,共5页Journal of Qiqihar Medical University

基　　金：河南省医学科技攻关计划项目(LHGJ20200927)。

摘　　要：目的本研究旨在探讨ERAS理念下三种微创术式治疗胆囊结石并胆总管结石的临床比较。方法选择2020年9月—2021年8月本院收治的149例胆囊结石并胆总管结石患者为研究对象,所有患者均进行ERAS理念管理,根据治疗方法的不同分为腹腔镜胆囊切除(LC)联合内镜逆行性胰胆管造影下十二指肠乳头切开取石术(ERCP+EST)(LC+ERCP+EST组,49例)、LC联合胆总管切口取石术及T管引流术(LCHTD)(LC+LCHTD组,57例)及LC联合胆总管切口取石术及一期缝合术(LCBDE)(LC+LCBDE组,43例)三组。记录三组手术成功率、手术指标(手术时间、术中出血量、胆总管结石数量、胆总管结石大小、术后排气时间、住院时间)及术后并发症发生情况进行统计,对比三组术后1 d、3 d、7 d的疼痛程度,观察术前、术后血清γ-谷氨酸转肽酶(GGT)、碱性磷酸酶(ALP)水平变化情况,统计术后4周的残石率。结果LC+LCBDE组、LC+ERCP+EST组、LC+LCHTD组手术成功率依次为95.35%(41/43)97.96%(48/49)、96.49%(55/57),差异无统计学意义(P>0.05);LC+LCBDE组、LC+ERCP+EST组、LC+LCHTD组残石率依次为6.98%(3/43)、4.08%(2/49)、1.75%(1/57),差异无统计学意义(P>0.05)。LC+LCBDE组手术时间、术中出血量、术后排气时间及住院时间均优于LC+ERCP+EST组、LC+LCHTD组,LC+ERCP+EST组手术时间、术中出血量、术后排气时间及住院时间优于LC+LCHTD组,差异有统计学意义(P<0.05);三组胆总管结石数量、胆总管结石大小及住院时间比较,差异无统计学意义(P>0.05)。三组术后1 d、3 d、7 d的疼痛程度比较,差异无统计学意义(P>0.05)。术前,三组GGT及ALP水平比较,差异无统计学意义(P>0.05);术后,三组GGT及ALP水平均较治疗前降低,三组GGT及ALP水平比较,差异无统计学意义(P>0.05)。三组术后并发症发生情况比较,差异无统计学意义(P>0.05)。结论ERAS理念下三种微创术式能够有效治疗胆囊结石并胆总管结石,其中LC+LCBDE手术�Objective To investigate the clinical comparison of three minimally invasive surgical procedures in the treatment of cholecystolithiasis complicated with choledocholithiasis under ERAS concept.Methods A total of 149 patients with cholecystolithiasis complicated with choledocholithiasis those were admitted to the first people’s hospital of Shangqiu from September 2020 to August 2021 were selected as the study objects.All patients received ERAS concept management.According to the different treatment methods,the patients were divided into three groups:49 cases of patients received laparoscopic cholecystectomy(LC)combined with endoscopic sphincterotomy for lithotomy under the guidance of endoscopic retrograde cholangiopancreatography(LC+ERCP+EST group),57 cases of patients received LC combined with laparoscopic choledocholithotomy T-tube drainage(LCHTD)(LC+LCHTD group),and 43 cases of patients received LC combined with laparoscopic transcystic common bile duct exploration(LCBDE)and primary suture(LC+LCBDE group).The success rate of surgery,surgical indicators(operative time,intraoperative blood loss,number of common bile duct calculi,size of common bile duct calculi,postoperative exhaust time,length of hospital stay)and postoperative complications of the three groups were recorded for statistics.The pain degree of the three groups was compared at 1 st d,3 rd d and 7 th d after surgery were compared.The serum levels ofγ-glutamate transpeptidase(GGT)and alkaline phosphatase(ALP)were observed before and after operation,and the residual stone rate at 4 th week after operation was calculated.Results The success rate of operation in LC+LCBDE group,LC+ERCP+EST group and LC+LCHTD group were 95.35%(41/43),97.96%(48/49),96.49%(55/57)and,respectively,and there was no significant difference among the three groups(P>0.05).The residual stone rate of LC+LCBDE group,LC+ERCP+EST group and LC+LCHTD group was 6.98%(3/43),4.08%(2/49),1.75%(1/57)and,respectively,with no statistical significance(P>0.05).The operative time,intraoperativ

关 键 词：ERAS理念 LC+ERCP+EST LC+LCHTD LC+LCBDE 胆囊结石并胆总管结石 临床疗效 

分 类 号：R657.4[医药卫生—外科学]