经胆囊管汇入部切开胆总管探查术治疗胆囊结石合并胆总管结石的效果观察  

Observation on effects of laparoscopic transcystic common bile duct exploration in the treatment of gallbladder stones with common bile duct stones

作　　者：唐建坡 李岩 TANG Jian-po;LI Yan(Department of General Surgery I,Zhangjiakou First Hospital,Zhangjiakou 075000,Hebei,China;Department of Geriatrics I,Zhangjiakou First Hospital,Zhangjiakou 075000,Hebei,China)

机构地区：[1]张家口市第一医院普外一科,河北张家口075000 [2]张家口市第一医院老年病一科,河北张家口075000

出　　处：《川北医学院学报》2022年第6期738-741,共4页Journal of North Sichuan Medical College

基　　金：河北张家口市科学技术研究与发展计划项目(1621054D)。

摘　　要：目的:探讨经胆囊管汇入部切开胆总管探查术(LTCBDE)治疗胆囊结石合并胆总管结石的疗效。方法:选取150例胆囊结石合并胆总管结石患者为研究对象,根据治疗方式不同分为对照组(n=82)和观察组(n=68)。对照组患者行传统开腹取石术治疗;观察组行LTCBDE治疗。比较两组患者围手术期参数、术后并发症、手术前后胆囊相关生化指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、直接胆红素(DBil)、总胆红素(TBil)]水平、应激指标[皮质醇(Cor)、C-肽(C-P)、游离三碘甲状腺原氨酸(FT3)]水平及随访复发情况。结果:观察组患者手术耗时、术中出血量、腹腔引流时间、肛门排气时间、住院时间短于对照组(P<0.05);两组患者结石清除率比较,差异无统计学意义(P>0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。术后3 d,两组患者AST、ALT、DBil、TBil均较术前降低(P<0.05),但组间比较差异无统计学意义(P>0.05);两组血清Cor、C-P均较术前升高(P<0.05),且观察组低于对照组(P<0.05);FT3均较术前降低(P<0.05),且观察组高于对照组(P<0.05)。术后随访6个月,两组患者结石复发率比较,差异无统计学意义(P>0.05)。结论:LTCBDE治疗胆囊结石合并胆总管结石疗效可靠,并发症少,且手术引起的应激反应更轻,术后恢复更快。Objective:To observe the efficacy of laparoscopic transcystic common bile duct exploration(LTCBDE)in the treatment of gallbladder stones with common bile duct stones.Methods:150 patients with gallbladder stones with common bile duct stones were selected as the research objects.They were divided into control group(n=82)and observation group(n=68)according to different treatment methods.The patients in the control group were treated with traditional laparotomy lithotomy,and the observation group was treated with LTCBDE.The perioperative parameters,postoperative complications,gallbladder-related biochemical indicators[aspartate aminotransferase(AST),alanine aminotransferase(ALT),direct bilirubin(DBil),total bilirubin(TBil)]and stress indicators[cortisol(Cor),C-peptide(CP),free triiodothyronine(FT3)]before and after surgery and follow-up recurrence status were compared between the two groups.Results:The surgical time,intraoperative blood loss,abdominal drainage time,anal exhaust time and hospital stay in observation group were shorter than those in control group(P<0.05),and there was no statistically significant difference in the stone clearance rate between the two groups(P>0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).At 3 d after surgery,the levels of AST,ALT,DBil and TBil in the two groups were reduced compared with those before surgery(P<0.05),and there were no statistical differences between the two groups(P>0.05),and serum Cor and CP in both groups were increased compared to before surgery(P<0.05),the levels in observation group were lower than those in control group(P<0.05),and the FT3 was lower than that before surgery(P<0.05),but the level in observation group was higher than that in control group(P<0.05).There was no statistical significance in the stone recurrence rate between observation group and control group at 6 months of follow-up after surgery(P>0.05).Conclusion:LTCBDE has reliable efficacy and less complications i

关 键 词：经胆囊管汇入部切开胆总管探查术 胆囊结石合并胆总管结石 皮质醇 C-肽 游离三碘甲状腺原氨酸 

分 类 号：R575.62[医药卫生—消化系统]