不同方案在胆总管结石合并胆囊结石患者中的效果研究  

Study on the effect of different regimens in patients with choledocholithiasis combined with cholecystolithiasis and the influence of complications

作　　者：张媛 朱苏敏 赵旋 石丽红 唐成祥 郭思明 Zhang Yuan;Zhu Sumin;Zhao Xuan;Shi Lihong;Tang Chengxiang;Guo Siming

机构地区：[1]徐州医科大学第二附属医院消化内科,徐州221000

出　　处：《中国临床实用医学》2023年第2期15-19,共5页China Clinical Practical Medicine

基　　金：徐州市科技项目(KC22210)。

摘　　要：目的探讨不同方案在胆总管结石合并胆囊结石患者中的效果研究。方法本研究为随机对照研究,选取2021年1月至2022年10月徐州医科大学第二附属医院消化内科收治的110例胆总管结石合并胆囊结石患者,男49例,女61例,年龄(40.15±5.27)岁,年龄范围为26~65岁。根据治疗方法的不同将其分为腹腔镜组(n=55)及内镜组(n=55),腹腔镜组行腹腔镜胆囊切除与胆总管切除开取石手术,内镜组行内镜逆行性胰胆管造影术联合腹腔镜胆囊切除术,比较两组患者取石成功率、手术情况、并发症发生情况、视觉模拟疼痛评分法(VAS)评分情况、胆汁引流量及C反应蛋白(CRP)水平。结果腹腔镜组患者取石成功率[100%(55/55)]与内镜组[100%(55/55)]比较,差异无统计学意义(P>0.05)。内镜组患者手术耗时[(38.56±5.23)min]、胃肠道功能恢复时间[(27.34±3.82)h]、住院时间[(6.12±1.06)d]短于腹腔镜组[(89.34±10.23)min、(44.23±4.76)h、(9.23±1.25)d]、出血量[(9.45±1.25)ml]及住院费用[(1.96±0.38)万元]少于腹腔镜组[(31.25±3.21)ml、(2.56±0.58)万元],差异有统计学意义(P<0.05)。内镜组并发症发生率[3.6%(2/55)]低于腹腔镜组[14.5%(8/55)],差异有统计学意义(P<0.05)。术后1、4、7 d,内镜组患者VAS评分[(4.15±0.39)分、(2.86±0.49)分、(0.93±0.16)分]低于腹腔镜组[(6.69±0.56)分、(4.12±0.28)分、(1.62±0.34)分];术后1、3 d,内镜组患者胆汁引流量[(72.35±3.23)ml、(202.53±4.23)ml]低于腹腔镜组[(95.23±2.95)ml、(220.65±6.23)ml];术后1 d,内镜组患者CRP水平[(84.23±6.23)mg/L]低于腹腔镜组[(99.45±10.52)mg/L],差异有统计学意义(P<0.05)。结论内镜逆行性胰胆管造影术联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石手术效果较好,患者创伤小,恢复好,且安全可靠。Objective Study on the effect of different schemes in patients with choledocholithiasis combined with cholecystolithiasis.Methods This study was a randomized controlled study,a total of 110 patients with choledocholithiasis combined with cholecystolithiasis admitted to the Gastroenterology department of the Second Affiliated Hospital of Xuzhou Medical University from January 2021 to October 2022 were selected,including 49 males and 61 females,aged(40.15±5.27)years old,ranging from 26 to 65 years old.According to different treatment methods,they were divided into laparoscopic group(n=55)and endoscopic group(n=55).Laparoscopic cholecystectomy and choledocholithotomy were performed in the laparoscopic group,while endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy was performed in the endoscopic group.The success rate of stone removal,operation,complications,visual analogue scale(VAS)score,bile drainage volume and C-reactive protein(CRP)level were compared between the two groups.Results There was no significant difference in the success rate of stone removal between the laparoscopic group[100%(55/55)]and the endoscopic group[100%(55/55)]the difference was no statistically significant(P>0.05).The operation time[(38.56±5.23)min],gastrointestinal function recovery time[(27.34±3.82)h]and hospital stay[(6.12±1.06)d]in the endoscopic group were shorter than those in the laparoscopic group[(89.34±10.23)min,(44.23±4.76)h,(9.23±1.25)d],the amount of blood loss[(9.45±1.25)ml]and the hospitalization cost[(1.96±0.38 million yuan)]were less than those of the laparoscopic group[(31.25±3.21)ml,(2.56±0.58)million yuan],the differences were statistically significant(P<0.05).The complication rate of endoscopy group[3.6%(2/55)]was lower than that of laparoscopy group[14.5%(8/55)],and the difference was statistically significant(P<0.05).On day 1,4 and 7 after surgery,VAS scores in endoscopic group[(4.15±0.39)points,(2.86±0.49)points,(0.93±0.16)points]were lower than those in laparosco

关 键 词：内镜逆行性胰胆管造影术 腹腔镜胆囊切除术 胆总管结石合并胆囊结石 取石成功率 并发症 胆汁引流 

分 类 号：R657.4[医药卫生—外科学]