两种微创术式治疗胆囊切除术后胆总管结石的疗效影响  

Efficacy of ERCP and LCBDE in the treatment of common bile duct stones after cholecystectomy

作　　者：蒋辉 詹刚 周骏 李中虎 马丹丹 孙炜玮 谢俊 JIANG Hui;ZHAN Gang;ZHOU Jun;LI Zhonghu;MA Dandan;SUN Weiwei;XIE Jun(Department of General Surgery,General Hospital of Central Theater Command,Wuhan 430070,Hubei,China;Department of Hepaticbiliary-pancreatic Surgery,Army Medical Center,Chongqing 400042,China)

机构地区：[1]中部战区总医院普通外科,武汉430070 [2]陆军特色医学中心肝胆胰外科,重庆400042

出　　处：《东南国防医药》2023年第1期1-6,共6页Military Medical Journal of Southeast China

基　　金：国家自然科学基金(81902501)。

摘　　要：目的探讨内镜逆行胰胆管造影术(ERCP)与腹腔镜胆总管切开探查术(LCBDE)治疗胆囊切除术后胆总管结石的疗效及对应激反应、白细胞计数(WBC)及谷氨酰转移酶(GGT)的影响。方法回顾性分析2019年5月-2021年11月中部战区总医院收治的98例胆囊切除术后胆总管结石患者的临床资料,根据手术方式分为ERCP组(行ERCP+内镜十二指肠乳头括约肌切开术(EST)治疗,37例)和LCBDE组(行LCBDE治疗,61例)。比较2组患者手术相关指标、术后并发症发生情况以及手术前后应激反应指标[C-肽(C-P)、皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)]、WBC、GGT水平变化。结果ERCP组患者手术时间[(60.54±7.74)min vs(109.44±10.71)min]、术中出血量[(5.73±1.67)mL vs(30.92±5.16)mL]、术后排气时间[(12.30±3.77)h vs(18.54±4.69)h]、下床活动时间[(1.11±0.37)d vs(1.44±0.50)d]、术后住院时间[(5.14±1.09)d vs(6.28±1.28)d]、治疗费用[(2.51±0.51)万元vs(3.08±0.57)万元]均小于LCBDE组患者(均P<0.05),2组患者的结石残留率比较,差异无统计学意义(P>0.05)。术后24 h、72 h,2组患者血清C-P、Cor、NE、ACTH、WBC水平均高于术前(均P<0.05),且ERCP组患者上述指标均高于LCBDE组患者(均P<0.05);术后24 h、72 h、7 d,2组患者血清GGT水平均低于术前水平(均P<0.05)。2组患者术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论ERCP与LCBDE治疗胆囊切除术后胆总管结石的疗效及安全性均尚可,LCBDE相较ERCP对患者的应激反应指标、WBC及GGT水平影响更小,临床应用价值相对更高,但仍需根据患者实际情况选择最优术式。Objective To investigate the efficacy of endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic choledocholithotomy(LCBDE)in the treatment of common bile duct stones after cholecystectomy and their response to stress,white blood cell count(WBC)and glutamyltransferase(GGT).Methods A total of 98 patients with choledocholithiasis after cholecystectomy who were admitted from May 2019 to November 2021 in General Hospital of Central Theater Command were enrolled,and were divided into ERCP group(ERCP)+endoscopic sphincterotomy(EST)treatment,37 casesand LCBDE group(LCBDE treatment,61 cases).The operation-related indicators,postoperative complications,and stress response indicators C-peptide(C-P),cortisol(Cor),norepinephrine(NE),adrenocorticotropic hormone(ACTH)before and after surgery,WBC,GGT levels were compared.Results The operation time[(60.54±7.74)min vs(109.44±10.71)min],intraoperative blood loss[(5.73±1.67)mL vs(30.92±5.16)mL],postoperative exhaust time[(12.30±3.77)h vs(18.54±4.69)h],ambulation time[(1.11±0.37)d vs(1.44±0.50)d],postoperative hospital stay[(5.14±1.09)d vs(6.28±1.28)d],and treatment cost[(2.51±0.51)million vs(3.08±0.57)million]in the ERCP group were less than those in the LCBDE group(All P<0.05).There was no significant difference in the residual rate of stones among the patients(P>0.05).At the 24 h,72 h after operation,the serum levels of C-P,Cor,NE,ACTH,and WBC in the two groups were higher than those before operation(All P<0.05).And the patients in the ERCP group were higher than those in the LCBDE group(All P<0.05).At 24 h,72 h,and 7 d after the operation,the serum GGT levels in the two groups were lower than the preoperative level(All P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion The efficacy and safety of ERCP and LCBDE in the treatment of common bile duct stones after cholecystectomy are acceptable.Compared with ERCP,LCBDE has less effect on the stress response index,WBC and

关 键 词：内镜逆行胰胆管造影术 腹腔镜胆总管切开探查术 胆囊切除术 胆总管结石 疗效 应激反应 白细胞计数 谷氨酰转移酶 

分 类 号：R657.4[医药卫生—外科学]