胆囊结石合并胆总管结石患者应用ERCP联合LC治疗的临床效果评估  

Clinical curative effect of ERCP combined with LC in gallbladder stone combined with common bile duct stone

作　　者：王建超 张怀波[1] 白英伟[1] WANG Jianchao;ZHANG Huaibo;BAI Yingwei(Department of Hepatobiliary,Pancreatic and GastrSurgery,Puyang Oilfield General Hospital,Puyang 457001,China)

机构地区：[1]濮阳市油田总医院肝胆胰胃外科,河南濮阳457001

出　　处：《黑龙江医药科学》2024年第2期74-77,共4页Heilongjiang Medicine and Pharmacy

摘　　要：目的:评估胆囊结石合并胆总管结石(CCL)患者应用十二指肠镜下胆总管取石术(ERCP)联合腹腔镜胆囊切除术(LC)治疗的临床效果。方法:选取濮阳市油田总医院于2021年1月至2023年3月收治的CCL患者(n=116),根据手术方法不同将纳入患者分为对照组(n=52)和观察组(n=64)。对照组患者实行腹腔胆总管探查取石术(LCBDE)联合LC治疗,观察组患者实行ERCP联合LC治疗。对比两组患者术中情况、术后临床恢复情况、术前术后白细胞数量和炎症因子[包括降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]、术后并发症发生情况。结果:两组患者结石清除率无差异(P>0.05);观察组患者手术时间为(135.26±28.96)min明显长于对照组的(97.52±18.16)min(P<0.05),术中出血量为(58.32±15.63)mL少于对照组的(103.52±32.85)mL(P<0.05),治疗总费用高于对照组(P<0.05);观察组患者术后肠鸣恢复、排气时间短于对照组(P<0.05),术后住院时间、术后总住院时间高于对照组(P<0.05);两组患者手术后白细胞数量和炎症因子含量均明显高于手术前(P<0.05),且观察组患者术后白细胞数量和炎症因子含量均明显低于对照组(P<0.05),两组术后并发症发生率差异无统计学意义(P>0.05)。结论:CCL患者应用ERCP联合LC治疗对比LCBDE联合LC治疗,两种手术方法各有优势,ERCP联合LC治疗手术时间和住院时间更长,手术费用也更高,但能减少患者术中出血量,减少手术损伤,降低炎症反应程度。Objective:To evaluate the clinical effect of the treatment of laparoscopic cholecystectomy(ERCP)in patients with choleolithiasis(CCL).Methods:CCL patients(n=116)admitted to Puyang Oilfield General Hospital from January 2021 to March 2023 were selected,and the patients were divided into control(n=52)and observation(n=64).Patients in the control group underwent celiac common bile duct exploration stone extraction(LCBDE)combined with LC,and patients in the observation group received ERCP combined with LC.The intraoperative conditions,postoperative clinical recovery,postoperative number of white blood cells and inflammatory factors[including procalcitonin(PCT),tumor necrosis factor(TNF-α),C-reactive protein(CRP)],and the occurrence of postoperative complications were compared.Results:There was no difference in stone clearance between the two groups(P>0.05);The operation time of patients in the observation group was(135.26±28.96),significantly longer than the control(97.52±18.16)(P<0.05),However,the intraoperative blood loss was(58.32±15.63)mL less than the control group(103.52±32.85)mL(P<0.05),The total cost of treatment was higher than that of the control group(P<0.05);Patients in the observation group had shorter bowel recovery and exhaust gas time than the control group(P<0.05),Postoperative hospital stay and total postoperative hospital stay were higher than that of the control group(P<0.05);The number of white blood cells and the content of inflammatory factors were significantly higher after surgery than before surgery(P<0.05),Moreover,the number of leukocytes and inflammatory factors in the observation group were significantly lower than that in the control group(P<0.05),There was no significant difference in the postoperative complication rate between the two groups(P>0.05).Conclusion:Compared with ERCP combined with LC,CCL patients have different advantages.ERCP combined with LC has longer operation time and hospital time,and the operation cost is higher,but it can reduce the amount of intraoperative bl

关 键 词：胆囊结石合并胆总管结石患者 十二指肠镜下胆总管取石术 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]