ERCP+EST术后早期行LC术治疗胆囊结石合并胆总管结石临床疗效分析  

Analysis of Clinical Efficacy of Early LC after ERCP+EST for Gallbladder Stones Combined with Common Bile Duct Stones

作　　者：蒋浩 俞林冲 何建新 JIANG Hao;YU Linchong;HE Jianxin(Department of General Surgery,Nantong Haimen District Hospital of Traditional Chinese Medicine,Nantong,Jiangsu Province,226100 China)

机构地区：[1]江苏省南通市海门区中医院普外科,江苏南通226100

出　　处：《系统医学》2023年第15期139-142,共4页Systems Medicine

摘　　要：目的探讨经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)+内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)术后早期行腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)对胆囊结石合并胆总管结石的治疗效果。方法选取2019年1月—2022年12月江苏省南通市海门区中医院收治的97例患者,以随机掷骰子法分为对照组(n=48)、观察组(n=49)。对照组行开腹手术,观察组行ERCP+EST术后早期行LC术,对比两组治疗成功率、手术情况、疼痛程度、并发症,并复查血常规与肝功能。结果与对照组比较,观察组手术成功率更高,结石残留率更低,差异有统计学意义(P<0.05)。与对照组比较,观察组术中出血量更少,术后肛门排气时间、下床活动时间及住院时间均更短,手术时间更长,差异有统计学意义(P<0.05)。术后6、12、24、48 h,观察组疼痛评分更低,差异有统计学意义(P<0.05)。观察组的并发症发生率(2.04%)低于对照组(18.75%),差异有统计学意义(χ^(2)=5.625,P<0.05)。结论ERCP+EST术后早期行LC术,对胆囊结石并胆总管结石应用疗效明显,出血量少,术后恢复快,可减轻术后疼痛,且术后并发症发生率低。Objective To investigate the therapeutic effect of early laparoscopic cholecystectomy(LC)after endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic sphincterotomy(EST)on gallbladder stones combined with common bile duct stones.Methods 97 patients admitted to Haimen District Hospital of Traditional Chinese Medicine in Nantong City,Jiangsu Province from January 2019 to December 2022 were randomly divided into a control group(n=48)and an observation group(n=49)using a dice rolling method.The control group underwent open surgery,while the observation group underwent early LC surgery after ERCP+EST.The success rate,surgical condition,pain level,complications,and blood routine and liver function were compared between the two groups.Results Compared with the control group,the observation group had a higher success rate of surgery and a lower residual rate of stones,the difference was statistically significant(P<0.05).Compared with the control group,the observation group had less intraoperative bleeding,shorter postoperative anal exhaust time,ambulatory time,and hospital stay,and longer surgical time,the difference was statistically significant(P<0.05).At 6,12,24,and 48 hours after surgery,the pain score in the observation group was lower,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group(2.04%)was lower than that in the control group(18.75%),the difference was statistically significant(χ^(2)=5.625,P<0.05).Conclusion Early LC after ERCP+EST has obvious efficacy in the application of gallbladder stones with choledocholithiasis,with less bleeding,fast postoperative recovery,which can reduce postoperative pain,and a low incidence of postoperative complications.

关 键 词：胆总管结石 腹腔镜胆囊切除术 胆囊结石 结石残留 疼痛程度 

分 类 号：R4[医药卫生—临床医学]