三镜联合分期手术与腹腔镜手术治疗老年胆总管结石合并胆囊结石患者疗效对比研究  

Stepped operation of ERCP and thereafter laparoscopic cholecystectomy and laparoscopic common bile duct exploration in the treatment of elderly patients with common bile duct stones and gallbladder stones

作　　者：方骏 王安 孙修勇[1] 孙春辉[1] 张炳远[2] 朱武晖[1] Fang Jun;Wang An;Sun Xiuyong(Department of Hepatobiliary Surgery,Third People's Hospital,Qingdao 266000,Shandong Province,China)

机构地区：[1]山东省青岛市第三人民医院肝胆外科,266000 [2]青岛大学附属医院肝胆外科

出　　处：《实用肝脏病杂志》2022年第5期730-733,共4页Journal of Practical Hepatology

基　　金：青岛市医药科研指导计划项目(编号:2018-WJZD066)。

摘　　要：目的探讨采用三镜联合分期手术与全腹腔镜同期手术治疗老年结石性胆道梗阻并发不同程度急性胆管炎患者的效果。方法回顾性分析青岛市第三人民医院收治的老年胆总管结石伴急性胆管炎合并胆囊结石患者75例,其中35例观察组患者在入院后急诊行ERCP术,取出胆总管结石或留置胆管支架引流,择期再次入院行腹腔镜胆囊切除术(LC)或LC联合腹腔镜下胆总管取石术(LCBDE),40例对照组患者入院后急诊行LC联合LCBDE术。结果观察组两次手术时间显著长于对照组(P<0.05),但术中出血量显著少于对照组(P<0.05);手术后观察组WBC计数、NEUT百分比、血清CRP和PCT水平均显著低于对照组(P<0.05);术后,观察组血清脑钠肽(BNP)和CK水平分别为(427.0±327.0)pg/ml和(95.0±30.0)U/L,显著低于对照组【分别为(944.0±648.0)pg/ml和(149.0±67.0)U/L,P<0.05】,而血清肌钙蛋白(TNT)和乳酸脱氢酶(LDH)水平分别为(62.8±54.5)pg/ml和(272.0±48.0)U/L,显著高于对照组【分别为(30.5±17.1)pg/ml和(229.0±32.0)U/L,P<0.05】。结论采用三镜联合分期手术治疗老年重症急性胆管炎患者,特别是合并有心肌损伤或心功能下降患者能顺利康复,不影响心功能。Objective The aim of this study was to investigate the efficacy of step by step three-endoscope surgery in the treatment of patients with calculous biliary obstruction and acute cholangitis.Method In our series,75 elderly patients with common bile duct stones and gallbladder stones and acute cholangitis were recruited in our hospital,and the emergent endoscopic retrograde cholangiopancreatography(ERCP)was performed and the elective laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)were completed thereafter in 35 patients in observation group and the emergent LC and LCBDE were done in 40 patients in control.Result The operation time in the observation group was much longer than in the control(P<0.05),while the intraoperative bleeding was significantly less than in the control group(P<0.05);the white blood cell counts,the percentage of neutrophils,serum C-reactive protein and procalcitonin levels in the observation group were much lower than in the control(P<0.05);3 days after operation,serum brain natriuretic peptide(BNP)and creatine kinase in the observation were(427.0±327.0)pg/ml and(95.0±30.0)U/L,significantly lower than[(944.0±648.0)pg/ml and(149.0±67.0)U/L,respectively,P<0.05],while serum troponin T(TNT)and lactate dehydrogenase(LDH)levels were(62.8±54.5)pg/ml and(272.0±48.0)U/L,both significantly higher than[(30.5±17.1)pg/ml and(229.0±32.0)U/L,respectively,P<0.05]in the control group.Conclusion The emergent ERCP could quickly get rid of biliary obstruction and make it possible for elective LC and LCBDE in patients with common bile duct stones and gallbladder stones and acute cholangitis,which warrants further clinical investigation.

关 键 词：胆总管结石 急性胆管炎 胆囊结石 内镜逆行胰胆管造影术 腹腔镜胆囊切除术 腹腔镜下胆总管取石术 治疗 

分 类 号：R657.42[医药卫生—外科学]