LC联合ERCP治疗胆囊结石合并肝外胆管结石对患者术后肝功能及炎症反应的影响  

Effects of LC combined with ERCP on liver function and complications in cholecystolithiasis combined with extrahepatic bile duct stones

作　　者：张杨[1] 寇艳[2] 徐春梅 王利琴 吴涛 ZHANG Yang;KOU Yan;XU Chun-mei;WANG Li-qin;WU Tao(Department of Hepatobiliary,Pancreatic and Splenic Surgery,Luzhou People's Hospital,Luzhou 646000,Sichuan,China;Department of Electrocardiography,Luzhou People's Hospital,Luzhou 646000,Sichuan,China;Department of Public Health and Preventive Care,Luzhou People's Hospital,Luzhou 646000,Sichuan,China)

机构地区：[1]泸州市人民医院肝胆胰脾外科,四川泸州646000 [2]泸州市人民医院心电图科,四川泸州646000 [3]泸州市人民医院公共卫生与预防保健部,四川泸州646000

出　　处：《川北医学院学报》2023年第8期1053-1057,共5页Journal of North Sichuan Medical College

基　　金：四川省医院管理和发展研究中心科研项目(SCYG2021-16)。

摘　　要：目的:探讨腹腔镜下胆囊切除术(LC)联合逆行胰胆管造影(ERCP)治疗胆囊结石合并肝外胆管结石对患者术后肝功能及炎症反应的影响。方法:选取120例胆囊结石合并肝外胆管结石患者为研究对象,根据治疗方式不同将患者分为A组(n=43)和B组(n=77)。A组患者接受LC联合ERCP治疗;B组患者接受开腹手术治疗。比较两组患者手术和住院时间、术中出血量、肝功能(ALT、AST、TBIL)、血管紧张素(AngⅠ、AngⅡ、Ang1-7)、炎症因子水(TNF-α、IL-6、CRP)平、并发症和结石复发情况。结果:A组患者手术和住院时间均短于B组(P<0.05),术中出血量低于B组(P<0.05)。术后,A组患者肝功能各指标均高于B组(P<0.05),血管紧张素、炎症因子相关指标及并发症发生率均低于B组。两组结石残留及复发率比较,差异均无统计学意义(P>0.05)。结论:LC联合ERCP治疗胆囊结石合并肝外胆管结石,患者手术和住院时间更短,术中出血量更低,且可改善患者肝功能,降低血管紧张素水平,减轻炎症反应,减少并发症发生,值得临床推广应用。Objective:To explore the curative effect of laparoscopic cholecystectomy(LC)combined with endoscopic retrograde cholangiopancreatography(ERCP)on liver function and complications in cholecystolithiasis combined with extrahepatic bile duct stones.Methods:120 patients with cholecystolithiasis and extrahepatic bile duct stones were selected as the research subjects,and divided into group A(n=43,LC combined with ERCP)and group B(n=77,laparotomy)according to different treatment methods.The operation time,hospitalization time,intraoperative blood loss,liver function,angiotensin and inflammatory factors before and after surgery,complications and stone recurrence rate in the two groups were compared.Results:Compared with group B,operation time and hospitalization time were shorter,and intraoperative blood loss was less in group A(P<0.05).Compared with group B,levels of liver function was better,angiotensin,inflammatory factors and the incidence of complications was lower in group A(P<0.05).There was no statistically significant difference in the residual and recurrence rates of stones between the two groups(P>0.05).Conclusion:LC combined with ERCP has shorter operation time,hospitalization time and less intraoperative blood loss,which can improve liver function and angiotensins,reduce inflammatory response and complications in cholecystolithiasis combined with extrahepatic bile duct stones.It is worthy of clinical promotion and application.

关 键 词：腹腔镜胆囊切除 逆行胰胆管造影 胆囊结石 肝外胆管结石 肝功能 

分 类 号：R657.4[医药卫生—外科学]