LC联合ERCP和EST治疗胆囊结石合并肝外胆管结石患者疗效研究  

Early LC after ERCP and EST is beneficial in the treatment of patients with simultaneous gallbladder and extrahepatic bile duct stones

作　　者：吴正东 徐刚[1] 慕海峰[1] 陈升宝[1] 班坤锋 Wu Zhengdong;Xu Gang;Mu Haifeng(Department of General Surgery,Tongren Hospital,Southeast University School of Medicine,Nanjing 222200,Jiangsu Province,China)

机构地区：[1]东南大学医学院附属南京同仁医院普外科,南京市222200

出　　处：《实用肝脏病杂志》2023年第3期432-435,共4页Journal of Practical Hepatology

基　　金：南京市科技局科研基金资助项目(编号:2021HJ02015)。

摘　　要：目的 分析比较内窥镜逆行胰胆管造影术(ERCP)联合内窥镜下括约肌切开术(EST)后何时进行腹腔镜胆囊切除术(LC)治疗胆囊结石合并肝外胆管结石患者更有效且安全。方法 2019年4月~2022年4月我院收治的65例胆囊结石合并肝外胆管结石患者,被随机分为两组,均首先接受ERCP联合EST术治疗,其中35例观察组患者在ERCP联合EST术后48h内行LC术,另30例对照组患者在ERCP联合EST术后48~72 h内行LC术。采用免疫比浊法检测血清C反应蛋白(CRP),采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平。结果 观察组术中出血量、术后住院日和住院费用分别为(15.6±2.3)ml、(8.3±0.9)d和(1.9±0.2)万元,显著少于或短于对照组【分别为(34.7±4.1)ml、(12.3±1.5)d和(2.4±0.3)万元,P<0.05】,而两组LC手术时间、中转开腹率和结石清除率比较,无显著性差异(P>0.05);术前术后,两组血清TBIL、AST、ALT和ALB水平无显著性差异(P>0.05);术后,观察组外周血WBC计数和血清CRP水平分别为(14.3±1.7)×10^(9)/L和(25.5±2.3)mg/L,显著高于对照组【分别为(12.8±2.5)×10^(9)/L和(18.7±3.4)mg/L,P<0.05】,而两组血清IL-6和TNF-α水平无显著性相差【分别为(33.1±6.5)μg/L和(21.8±2.7)μg/mL对(36.8±38.2)μg/L和(20.2±3.1)μg/mL,P<0.05】;术后,两组并发症,如胆管炎、切口感染、胆道出血、胆漏和胰腺炎等发生率比较无显著性差异(8.6%对23.3%,P>0.05)。结论 在采取ERCP联合EST术治疗肝外胆管结石患者后尽早进行LC术可缩短住院时间,减少医疗花费,值得进一步探索。Objective The aim of this study was to investigate whether the earlylaparoscopic cholecystectomy(LC)after endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic sphincterotomy(EST)is beneficialin the treatment of patients with simultaneous gallbladder and extrahepatic bile duct stones.Methods A retrospective analysis was performed on the clinical data of 65 patients with gallbladder and extrahepatic bile duct stones who were admitted to our hospital between April 2019 and April 2022,and all patients underwent ERCP and EST for removal of bile duct stones firstly.After that,35 patients in the observation group received LC within 48 h,and another 30 patients received in 48 h to 72 h later.Serum C-reactive protein(CRP)and peripheral blood white blood cell(WBC)counts were obtained.Serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)levels were assayed by ELISA.Results The intraoperative blood loss,hospital stay after operation and medical cost in the observation were(15.6±2.3)ml,(8.3±0.9)days and(19000±200)yuan,much less or shorter than[(34.7±4.1)ml,(12.3±1.5)days and(24000±300)yuan,P<0.05]in the control,while there were no significant differences as respect to operation times for LC,the conversion rates to laparotomy and the stone clearance rates between the two groups(P>0.05);before and after the operation,there were no significant differences respect to serum bilirubin,AST,ALT and albumin levels between the two groups(P>0.05);after the operation,the WBC count and serum CRP level in the observation were(14.3±1.7)×10^(9)/L and(25.5±2.3)mg/L,significantly higher than[(12.8±2.5)×10^(9)/L and(18.7±3.4)mg/L,respectively,P<0.05]in the control,while there were no significant differences as respect to serum IL-6 andTNF-αlevels between the two groups[(33.1±6.5)μg/L and(21.8±2.7)μg/mL vs.(36.8±38.2)μg/L and(20.2±3.1)μg/mL,P<0.05];there was no significant difference in the incidence of postoperative complications between the two groups(8.6%vs.23.3%,P>0.05).Conclusion For patients with

关 键 词：胆囊结石 肝外胆管结石 腹腔镜胆囊切除术 内窥镜逆行胰胆管造影术 内窥镜下括约肌切开术 治疗 

分 类 号：R657.4[医药卫生—外科学]