ERBD+LCBDE与ENBD+ERCP/EST在胆总管结石合并中重度急性胆管炎中的近期疗效对比  

Comparison of short-term efficacy between ERBd+LCBdE and ENBd+ERCP/EST in the treatment of choledocholithiasis complicated with moderate to severe acute cholangitis

作　　者：鲁为朋 孙礼侠 王晨[2] 刘志刚[1] LU Weipeng;SUN Lixia;WANG Chen;LIU Zhigang(Department of Hepatobiliary Surgery,Wuhu Hospital,East China Normal University,Wuhu,Anhui 241000,China;Department of Emergency Surgery,Wuhu Hospital,East China Normal University,Wuhu,Anhui 241000,China)

机构地区：[1]华东师范大学附属芜湖医院肝胆外科,安徽芜湖241000 [2]华东师范大学附属芜湖医院急诊外科,安徽芜湖241000

出　　处：《肝胆胰外科杂志》2023年第1期40-45,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：安徽省“十四五”临床重点专科项目(皖卫教科发(2021)1号);芜湖市卫健委项目(WHWJ2021y021)。

摘　　要：目的比较内镜下胆道支架引流(ERBD)+腹腔镜下胆总管探查(LCBDE)与内镜下鼻胆管引流(ENBD)+经内镜逆行胰胆管造影(ERCP)/内镜下乳头括约肌切开(EST)治疗在胆总管结石合并中重度急性胆管炎中的应用效果,探索理想的治疗组合方式。方法回顾性分析华东师范大学附属芜湖医院2020年1月至2021年6月收治的44例胆总管结石合并中重度急性胆管炎患者的临床资料。其中19例经ERBD引流后二期行LCBDE,作为研究组(n=19);25例经ENBD引流后二期行ERCP/EST取石治疗,作为对照组(n=25)。比较两种治疗方案的近期疗效差异。结果两组患者一般资料比较差异无统计学意义(P>0.05)。胆道引流前后,两组肝功能(TBIL、ALT、γ-GTP、ALP)及感染性指标(WBC、CRP、PCT),组间比较均无统计学差异(P>0.05);组内比较,引流后两组肝功能和感染性指标均较引流前明显下降,差异具有统计学意义(P<0.05)。两组住院总时间、住院总费用、取石成功率均无统计学差异(P>0.05)。研究组一次性结石取净率高于对照组[94.74%(18/19)vs 64.00%(16/25),χ^(2)=4.189,P=0.041],且近期总并发症发生率低于对照组[10.53%(2/19)vs 44.00%(11/25),χ^(2)=5.811,P=0.016]。结论ERBD+LCBDE、ENBD+ERCP/EST两种方案治疗胆总管结石(长径≥15 mm或结石数目≥3枚)合并中重度急性胆管炎均安全有效,但ERBD+LCBDE较ENBD+ERCP/EST在一次性结石清除率、近期并发症发生率方面更具优势。Objective To compare the short-term efficacy of endoscopic retrograde biliary drainage(ERBD)+laparoscopic common bile duct exploration(LCBDE)and endoscopic nasobiliary drainage(ENBD)+endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(EST)in treatment of choledocholithiasis complicated with moderate to severe acute cholangitis.Methods The clinical data of 44 patients with choledocholithiasis combined with moderate to severe acute cholangitis who admitted to Wuhu Hospital from Jan.2020 to Jun.2021 were retrospectively analyzed.Among the 44 patients,19 patients were treated with LCBDE in the second stage after ERBD,as the study group(n=19);25 patients were treated with ERCP/EST in the second stage after ENBD,as the control group(n=25).The differences in short-term efficacy and complication incidence between two groups were compared.Results There was no difference in general data between the two groups(P>0.05).Before and after biliary drainage,there was no significant difference in liver function(TBIL,ALT,γ-GTP,ALP)or infectious indexes(WBC,CRP,PCT)between the two groups(P>0.05);In both group,the liver function and infectious indexes after biliary drainage were significantly lower than those before biliary drainage(P<0.05).There was no significant difference in the total hospitalization time,total hospitalization expense,or success rate of stone removal between the two groups(P>0.05).The one-time stone clearance rate in the study group was higher than that in the control group[94.74%(18/19)vs 64.00%(16/25),χ^(2)=4.189,P=0.041];the rate of complications incidence in the study group was lower than that in the control group[10.53%(2/19)vs 44.00%(11/25),χ^(2)=5.811,P=0.016].Conclusion Both ERBD+LCBDE and ENBD+ERCP/EST are safe and effective in the treatment of choledocholithiasis(long diameter≥15 mm or stones number≥3)with moderate to severe acute cholangitis,and ERBD+LCBDE is superior to ENBD+ERCP/EST in terms of one-time stone clearance rate and recent complication incidence rate.

关 键 词：胆总管结石 急性胆管炎 内镜下胆道支架引流 腹腔镜下胆总管探查 内镜下鼻胆管引流 内镜下乳头括约肌切开 

分 类 号：R657.4[医药卫生—外科学]