LC序贯ERCP与LCBDE+LC胆总管一期缝合治疗胆囊结石合并胆总管结石患者的疗效分析  

Analysis of the Efficacy of LC Sequential ERCP and LCBDE+LC Common Bile Duct Primary Suture in the Treatment of Patients with Cholecystolithiasis and Choledocholithiasis

作　　者：陈勇[1,2] 张强 孙帅[3] 谢秋毅 姚捷 王小东 李振南 CHEN Yong;ZHANG Qiang;SUN Shuai;XIE Qiuyi;YAO Jie;WANG Xiaodong;LI Zhennan(College of Medicine,Yangzhou University,Yangzhou,Jiangsu,225009,China;Nanjing Gaochun People's Hospital,Nanjing,Jiangsu,211300,China;Graduate School,Dalian Medical University,Dalian,Liaoning,116000,China;Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou,Jiangsu,225009,China)

机构地区：[1]扬州大学医学院,江苏扬州225009 [2]南京市高淳人民医院,江苏南京211300 [3]大连医科大学研究生院,辽宁大连116000 [4]扬州大学附属苏北人民医院,江苏扬州225009

出　　处：《中外医疗》2024年第29期67-71,75,共6页China & Foreign Medical Treatment

基　　金：消化病/代谢病基础与临床转化重点实验室(YZ2020159)。

摘　　要：目的比较胆囊结石合并胆总管结石患者采用腹腔镜下胆囊切除(laparoscopic cholecystectomy,LC)序贯内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)与腹腔镜下胆囊切除合经胆总管胆道探查术(laparoscopic cholecystectomy combine with common bile duct exploration,LCBDE)+LC胆总管一期缝合治疗的临床效果。方法回顾性选取2019年1月—2020年12月扬州大学附属苏北人民医院肝胆胰外科中心收治的208例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序贯ERCP组和LCBDE+LC组,对比两组的围手术期指标(术中出血量、手术时间、术后拔管时间、术后进食时间)、术后近期并发症(胆漏、胰腺炎、高淀粉酶血症、胆管炎、消化道出血)和远期并发症(胆总管结石复发、胆总管狭窄)及术后6个月胆总管结石残留情况、肝功能指标。结果两组术中出血量、术后进食时间比较,差异无统计学意义(P均>0.05);LC序贯ERCP组手术时间长于LCBDE+LC组,住院费用高于LCBDE+LC组,术后拔管时间和住院时间短于LCBDE+LC组,差异有统计学意义(P均<0.05)。LC序贯ERCP组术后胆管炎发生率高于LCBDE+LC组,差异有统计学意义(P<0.05)。术后,LCBDE+LC组血清总胆红素>23.5μmol/L、丙氨酸氨基转移酶>50 U/L、白细胞计数>9.5×109/L的患者占比低于LC序贯ERCP组,差异有统计学意义(P均<0.05)。LC序贯ERCP组术后高淀粉酶血症及胰腺炎发生率为18.00%(18/100),高于LCBDE+LC组的0,术后胆漏发生率为0,低于LCBDE+LC组的11.11%(12/108),差异有统计学意义(χ^(2)=21.282、11.791,P均<0.05)。结论LC序贯ERCP组住院时间及术后恢复时间相对较短,LCBDE+LC胆总管一期缝合总体并发症的发生更少,术后肝功能恢复快,总体花费低,两组患者疗效和安全性均可靠。Objective The clinical effects of laparoscopic cholecystectomy(LC)combined with endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic cholecystectomy combine with common bile duct exploration(LCBDE)+primary suture of LC common bile duct in patients with cholecystolithiasis and choledocholithiasis were compared.Methods The clinical data of 208 patients with cholecystolithiasis and choledocholithiasis admitted to the Hepatobiliary and Pancreatic Surgery Center of Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January 2019 to December 2020 were retrospectively selected.According to different surgical methods,they were divided into LC sequential ERCP group and LCBDE+LC group.The perioperative indicators(intraoperative blood loss,operation time,postoperative extubation time,postoperative eating time),short-term postoperative complications(bile leakage,pancreatitis,hyperamylasemia,cholangitis,gastrointestinal bleeding)and long-term complications(re⁃currence of common bile duct stones,common bile duct stenosis)and residual common bile duct stones at 6 months af⁃ter operation and were compared between the two groups.Results There was no significant difference in intraoperative blood loss and postoperative feeding time between the two groups(both P>0.05).The operation time of LC sequential ERCP group was longer than that of LCBDE+LC group,the hospitalization cost was higher than that of LCBDE+LC group,the postoperative extubation time and hospitalization time were shorter than those of LCBDE+LC group,the dif⁃ferences were statistically significant(all P<0.05).The incidence of postoperative cholangitis in LC sequential ERCP group was higher than that in LCBDE+LC group,the difference was statistically significant(P<0.05).After operation,the proportion of patients with serum total bilirubin>23.5μmol/L,alanine aminotransferase>50 U/L and white blood cell count>9.5×109/L in LCBDE+LC group was lower than that in LC sequential ERCP group,and the differences were statistically sig

关 键 词：胆囊结石 胆总管结石 腹腔镜检查 胆总管一期缝合 内镜逆行胰胆管造影 

分 类 号：R657.42[医药卫生—外科学]