腹腔镜胆囊切除术联合胆道镜经胆囊管胆总管探查取石术治疗胆囊结石合并胆总管结石疗效  

Clinical evaluation of LC combined with LTCBDE in the treatment of cholecystolithiasis complicated with choledocholithiasis

作　　者：丁文辉 刘黎明 杨庭松[2] Ding Wenhui;Liu Liming;Yang Tingsong(Department of General Surgery,Shibei Hospital of Jing′an District,Shanghai 200435,China)

机构地区：[1]上海市静安区市北医院普通外科,200435 [2]上海市第十人民医院肝胆胰外科

出　　处：《山西医药杂志》2022年第6期606-610,共5页Shanxi Medical Journal

摘　　要：目的对比分析对胆囊结石合并胆总管结石患者应用腹腔镜胆囊切除术(LC)联合胆道镜经胆囊管胆总管探查取石术(LTCBDE)与开腹胆囊切除胆总管探查术(OCBDE)治疗的临床效果。方法回顾性分析2018年8月至2020年8月由上海市静安区市北医院普通外科收治的行手术治疗的120例胆囊结石并胆总管结石患者,其中行开腹手术(OCBDE组)和微创手术(LC联合LTCBDE组)各60例,统计分析2组手术方式对患者临床疗效影响的差异。结果2组患者手术成功率和残余结石率比较差异均无统计学意义(P>0.05),LTCBDE组术中出血量明显少于OCBDE组,手术时间、术后通气时间和住院时间明显短于OCBDE组,镇痛剂使用率、手术并发症发生率明显低于OCBDE组,差异均有统计学意义(P<0.01)。OCBDE组术后1 d、3 d、7 d和LC联合LTCBDE组术后1 d、3 d的血清炎症因子,包括肿瘤坏死因子-α、白细胞介素-6、C反应蛋白和淀粉酶(AMY)水平均明显高于术前,且LC联合LTCBDE组术后各时间点的血清炎症因子和AMY水平均明显低于OCBDE组,差异有统计学意义(P<0.05)。OCBDE组术后1 d、3 d、7 d及LTCBDE组术后1 d、3 d的天冬氨酸转氨酶(AST)、总蛋白(TP)和碱性磷酸酶(ALP)均明显高于术前,OCBDE组术后7 d的AST、TP和ALP也明显高于术前,LC联合LTCBDE组术后3 d的丙氨酸转氨酶明显低于OCBDE组,术后1 d、3 d的总胆红素明显低于OCBDE组,术后1 d、3 d、7 d的AST、TP和ALP均明显低于OCBDE组,差异有统计学意义(P<0.05)。结论LC联合LTCBDE具有手术创伤小、术后恢复快、并发症少等优势,是治疗胆囊结石合并胆总管结石更为安全和有效的手术方式。Objective To compare the clinical efficacy of laparoscopic cholecystectomy(LC)combined with laparoscopic transcystic common bile duct exploration(LTCBDE)and open surgery(OCBDE)in the treatment of cholecystolithiasis complicated with choledocholithiasis.Methods A total of 120 patients with cholecystolithiasis complicated with choledocholithiasis treated by the general surgery in Shibei Hospital of Jing'an District of Shanghai from August 2018 to August 2020 were retrospectively analyzed,including 60 cases of OCBDE(OCBDE group)and 60 cases of minimally invasive surgery(LC+LTCBDE group).Results There were no significant differences in operation success rate and residual stone rate between the two groups(P>0.05).The amount of intraoperative bleeding in LC+LTCBDE group was significantly less than that in OCBDE group,the operation time,postoperative ventilation time and hospital stay in LTCBDE group were significantly shorter than those in OCBDE group,and the utilization rate of analgesics and the incidence of surgical complications in LC+LTCBDE group were significantly lower than those in OCBDE group,the differences were statistically significant(P<0.01).The levels of serum tumor necrosis factor-α,interleukin-6,C-reactive protein and amylase(AMY)in the OCBDE group at 1,3 and 7 days after operation and in LTCBDE group at 1,3 days after operation were significantly higher than those before operation,and the levels of serum inflammatory factors and AMY in in LC+LTCBDE group at all time points after operation were significantly lower than those in OCBDE group,the differences were statistically significant(P<0.05).The levels of aspartate aminotransferase(AST),total protein(TP)and alkaline phosphatase(ALP)in the OCBDE group at 1,3 and 7 days after operation and the LTCBDE group at 1,3 days after operation were significantly higher than those before operation,the AST,TP and ALP of the OCBDE group at 7days after operation were also significantly higher than those before operation,the alanine aminotransferase of the LTCBDE gr

关 键 词：胆囊结石病 胆总管结石 胆囊切除术 腹腔镜 腹腔镜胆总管切开胆道镜探查取石术 

分 类 号：R657.4[医药卫生—外科学]