LC联合LCBDE与EST联合LC治疗胆囊结石合并胆总管结石的效果对比  

Comparison of Effects of LC Combined with LCBDE and EST Combined with LC in the Treatment of Gallstones Complicated with Common Bile Duct Stones

作　　者：戴贵森 方迎兵 DAI Guisen;FANG Yingbing(Longyan First Hospital Affiliated to Fujian Medical University,Longyan 364000,China;不详)

机构地区：[1]福建医科大学附属龙岩第一医院,福建龙岩364000

出　　处：《中外医学研究》2023年第3期139-142,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜下胆管下段Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆总管结石的效果及对患者炎症因子水平的影响。方法:选取2019年1月—2021年12月福建医科大学附属龙岩第一医院收治的176例胆囊结石合并胆总管结石患者作为研究对象,用随机数表法将其分为对照组和观察组,各88例。对照组接受EST+LC治疗,观察组接受LC+LCBDE治疗,比较两组疗效、围手术期指标、炎症因子、并发症等。结果:观察组一次性结石清除率为94.32%,低于对照组的95.45%,但差异无统计学意义(χ^(2)=0.1171,P>0.05)。观察组治疗费用少于对照组,住院时间短于对照组,手术时间长于对照组,差异均有统计学意义(t=4.9958、46.0574、24.1632,P<0.05);但两组首次下床活动时间、术中出血量比较,差异均无统计学意义(t=0.0000、0.0628,P>0.05)。两组术前肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、C反应蛋白(CRP)比较,差异无统计学意义(t=0.0061、0.0092、0.3235,P>0.05);观察组TNF-α、IL-8、CRP均低于对照组,差异均有统计学意义(t=6.4203、8.2981、39.5606,P<0.05)。观察组并发症发生率为2.27%,低于对照组的3.41%,但差异无统计学意义(χ^(2)=0.2058,P>0.05)。结论:LC+LCBDE与EST+LC治疗胆囊结石合并胆总管结石的效果相当,但前者炎症因子水平更低、住院时间更短,临床可根据患者实际状况综合确定治疗方式。Objective:To compare the effect of laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE),endoscopic sphincterotomy(EST)combined with LC in the treatment of gallstones complicated with common bile duct stones and its influence on the levels of inflammatory factors.Method:A total of 176 patients with gallstones complicated with common bile duct stones who treated in Longyan First Hospital Affiliated to Fujian Medical University from January 2019 to December 2021 were selected as the research object.They were divided into the control group and the observation group by random number table method,88 cases in each group.The control group was given EST+LC treatment and the observation group was given LC+LCBDE treatment.The therapeutic efficacy,perioperative indexes,inflammatory factors and complications of two groups were compared.Result:The one-time stone clearance rate in the observation group was 94.32%,which was lower than 95.45%in the control group,but the difference was not statistically significant(χ^(2)=0.1171,P>0.05).The treatment cost of the observation group was less than that of the control group,the length of hospital stay was shorter than that of the control group,the operation time was longer than that of the control group,the differences were statistically significant(t=4.9958,46.0574,24.1632,P<0.05);the activity time out of bed and the amount of intraoperative bleeding of two groups compared,the differences were not statistically significant(t=0.0000,0.0628,P>0.05).There were no significant differences in tumor necrosis factor-α(TNF-α),interleukin-8(IL-8)and C-reactive protein(CRP)between the two groups before surgery(t=0.0061,0.0092,0.3235,P>0.05);after surgery,TNF-α,IL-8 and CRP in observation group were lower than those in control group,and the differences were statistically significant(t=6.4203,8.2981,39.5606,P<0.05).The incidence of complications in the observation group was 2.27%,which was lower than 3.41%in the control group,but the difference was not

关 键 词：胆囊结石 胆总管结石 炎症因子 腹腔镜胆囊切除术 内镜下胆管下段Oddi括约肌切开术 腹腔镜胆总管探查术 

分 类 号：R657.4[医药卫生—外科学]