ERCP取石后不同时机行腹腔镜胆囊切除术对胆囊胆总管结石患者术后恢复的影响  

Effect of laparoscopic cholecystectomy at different time after ERCP on postoperative recovery of patients with choledocholithiasis

作　　者：胡杰 余倩 柴倩紫 张莉 HU Jie;YU Qian;CHAI Qianzi(Department of Gastroenterology,The First People's Hospital of Jiande,Jiande 311600,China)

机构地区：[1]建德市第一人民医院消化内科,浙江杭州311600 [2]建德市第一人民医院普外科,浙江杭州311600 [3]建德市第二人民医院骨科

出　　处：《全科医学临床与教育》2024年第8期711-714,共4页Clinical Education of General Practice

摘　　要：目的对比研究经内镜逆行胰胆管造影(ERCP)取石后不同时机行腹腔镜胆囊切除术(LC)对胆囊胆总管结石患者术后恢复的影响。方法回顾性选取200例胆囊胆总管结石患者,根据治疗方法分为两组,观察组100例于ERCP术后24~72 h内行LC术,对照组100例于ERCP术后72 h后行LC术,比较两组患者手术一般指标、胃肠功能、治疗疗效、治疗前后血清指标变化、肝功能及并发症发生率。结果观察组手术时间、术后住院时间、肠鸣音恢复时间、肛门排气时间均短于对照组(t分别=5.63、2.31、7.26、5.27,P均<0.05);观察组中转开腹率、结石清除率与对照组比较,差异均无统计学意义(P均>0.05),观察组再次入院率明显低于对照组(χ^(2)=3.66,P<0.05);观察组治疗后白细胞(WBC)、总胆红素(TBIL)与对照组比较,差异均无统计学意义(t分别=0.42、0.57,P均>0.05),但超敏C反应蛋白(hs-CRP)、天门冬氨酚氨基转移酶(ALT)、丙氨酸氨基转移酶(AST)水平明显低于对照组(t分别=4.31、3.03、3.46,P均<0.05);观察组总并发症发生率为5.00%低于对照组18.00%(χ^(2)=5.33,P<0.05)。结论对胆囊胆总管结石患者行ERCP取石后24~72 h内行LC术,能有效缩短患者住院时间,加快胃肠道功能恢复,降低再住院率,降低肝脏损伤,减少并发症发生,利于患者术后恢复。Objective To compare the effects of laparoscopic cholecystectomy(LC)at different times after endoscopic retrograde cholangiopancreatography(ERCP)on the postoperative recovery of patients with choledocholithiasis.Methods Totally 200 patients with choledocholithiasis were divided into two groups according to the treatment methods.Totally 100 patients in the observation group underwent LC within 24-72 hours after ERCP,and 100 patients in the control group underwent LC at 72 hours after ERCP.The general indexes of operation,gastrointestinal function,therapeutic effect,changes of serum indexes before and after treatment,liver function and complication were compared between the two groups.Results The observation group had shorter surgical time,postoperative hospitalization time,bowel sound recovery time,and anal exhaust time compared to the control group(t=5.63,2.31,7.26,5.27,P<0.05).The conversion rate to open surgery and stone clearance rate was not statistically different between two groups(P>0.05).The readmission rate in the observation group was significantly lower than that in the control group(χ^(2)=3.66,P<0.05).After treatment,there was no statistically significant difference in WBC and TBIL between the observation group and the control group(t=0.42,0.57,P>0.05).The hs CRP,ALT,and AST levels in the observation group were significantly lower than those in the control group(t=4.31,3.03,3.46,P<0.05).The total incidence of complications in the observation group was 5.00%,which was lower than the total incidence of complications in the control group,which was 18.00%(χ^(2)=5.33,P<0.05).Conclusion Undergoing LC within 24-72 hours after ERCP for choledocholithiasis can effectively shorten the hospitalization time,accelerate recovery of gastrointestinal function,reduce the readmission rate,improve the renal function,reduce the incidence of complications.And it is conducive to the postoperative recovery of patients.

关 键 词：内镜逆行胰胆管造影 腹腔镜胆囊切除术 胆囊胆总管结石 

分 类 号：R657.4[医药卫生—外科学]