腹腔镜胆囊切除术联合胆总管探查术后一期缝合与内镜逆行胰胆管造影治疗老年胆囊结石合并胆总管结石的效果  

Comparative study of laparoscopic cholecystectomy combined with primary suture after common bile duct exploration and endoscopic retrograde cholangiopancreatography in the treatment of elderly gallbladder stones with common bile duct stones

作　　者：佘小双 柯棠山 莫朝华 SHE Xiaoshuang;KE Tangshan;MO Chaohua(Department of Hepatobiliary and Pancreatic Surgery,Guizhou Aerospace Hospital,Zunyi,Guizhou,563000,China)

机构地区：[1]贵州航天医院肝胆胰外科,贵州遵义563000

出　　处：《当代医学》2024年第11期155-158,共4页Contemporary Medicine

摘　　要：目的探究腹腔镜胆囊切除术(LC)联合胆总管探查术后一期缝合与内镜逆行胰胆管造影(ERCP)治疗老年胆囊结石合并胆总管结石的效果。方法回顾性分析2020年1月至2022年7月贵州航天医院收治的91例老年胆囊结石合并胆总管结石患者的临床资料,根据手术方式不同分为LC组(经LC联合胆总管探查术后一期缝合治疗,n=47)和ERCP组(经ERCP治疗,n=44),比较两组围手术期指标、术后并发症发生情况及疼痛应激指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、5-羟色胺(5-HT)、去甲肾上腺素(NE)]。结果LC组手术时间及术后禁食时间均长于ERCP组,住院时间短于ERCP组,差异有统计学意义(P<0.05);两组术中出血量比较差异无统计学意义。LC组胃肠道反应、胰腺炎发生率均低于ERCP组,胆漏发生率高于ERCP组,差异有统计学意义(P<0.05);两组黄疸、术后出血发生率比较差异无统计学意义。术后3 d,两组CRP、IL-6、5-HT、NE水平均高于术前,差异有统计学意义(P<0.05);术前及术后3 d,两组CRP、IL-6、5-HT、NE水平比较差异无统计学意义。结论与ERCP相比,LC联合胆总管探查术后一期缝合不仅可缩短住院时间,还可保留患者Oddis括约肌功能,且术后并发症未见明显增加,值得临床推广应用。Objective To compare the effects of laparoscopic cholecystectomy(LC)combined with primary suture after common bile duct exploration and endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of elderly gallbladder stones with common bile duct stones.Methods The clinical data of 91 elderly patients with gallbladder stones and common bile duct stones who were treated in Guizhou Aerospace Hospital were retrospectively analyzed between January 2020 and July 2022.The patients were divided into the LC group(treated with LC combined with primary suture after common bile duct exploration,n=47)and ERCP group(treated with ERCP,n=44)according to different surgical methods.The perioperative indicators,postoperative complications and pain stress indicators(C-reactive protein[CRP],interleukin-6[IL-6],5-hydroxytryptamine[5-HT],norepinephrine[NE])were compared between the two groups.Results The operative time and postoperative fasting time in the LC group were longer than those in the ERCP group,and the hospitalization time was shorter than those in the ERCP group,and the differences were statistically significant(P<0.05),there was no significant difference in intraoperative blood loss between the two groups.The incidence of postoperative gastrointestinal reactions and pancreatitis in the LC group was lower than that in the ERCP group,and the incidence of bile leakage was higher than that in the ERCP group,and the differences were statistically significant(P<0.05);there was no statistical significance in the incidence of jaundice and postoperative bleeding between the two groups.At 3 d after operation,CRP,IL-6,5-HT and NE levels of the two groups were higher than those before operation,and the differences were statistically significant(P<0.05).There were no significant differences in CRP,IL-6,5-HT and NE levels between the two groups before and 3 d after operation.Conclusion Compared with ERCP,LC combined with primary suture after common bile duct exploration can not only shorten the hospitalization time,but also c

关 键 词：腹腔镜胆囊切除术 胆总管探查术后 一期缝合 内镜逆行胰胆管造影 胆囊结石 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]