胆囊结石并胆总管结石患者经LC+LTCBDE与ERCP/EST+LC的治疗效果  

Therapeutic effects of LC+LTCBDE and ERCP/EST+LC in the treatment of patients with cholecystolithiasis with choledocholithiasis

作　　者：魏广青 郭志刚 WEI Guangqing;GUO Zhigang(Linzhou Hospital of Traditional Chinese Medicine,Linzhou 456550,China)

机构地区：[1]林州市中医院,河南林州456550

出　　处：《临床医药实践》2025年第1期26-30,共5页Proceeding of Clinical Medicine

摘　　要：目的:对比分析胆囊结石并胆总管结石患者经腹腔镜胆囊切除术(LC)+经胆囊管胆总管探查取石术(LTCBDE)与内镜逆行胆管造影(ERCP)/括约肌切开取石术(EST)+LC的治疗效果。方法:回顾性分析2021年7月—2024年2月收治的118例胆囊结石并胆总管结石患者的临床资料,依据不同手术方法分为A组(64例)和B组(54例),A组行LC+LTCBDE治疗,B组行ERCP/EST+LC治疗。比较两组围术期相关指标、手术前后生化指标[碱性磷酸酶(ALP)、谷丙转氨酶(ALT)、总胆红素(TBIL)、谷氨酰转肽酶(GGT)]、炎性反应[白细胞介素-10(IL-10)、P物质(SP)、白细胞介素-8(IL-8)]及并发症。结果:与B组比较,A组住院时间、引流管置留时间、首次排气时间较短,住院费用较少,手术时间较长,出血量较多(P<0.05);术后7 d,与B组相比,A组血清ALP,ALT,TBIL,GGT水平较低(P<0.05);术后7 d,与B组相比,A组血清SP,IL-8水平较低,IL-10水平较高(P<0.05);A组并发症发生率低于B组(P<0.05)。结论:胆囊结石并胆总管结石患者行LC+LTCBDE能改善生化指标,减轻机体炎性反应,促进患者快速康复,安全性较好。Objective:To compare the therapeutic effects of laparoscopic cholecystectomy(LC)+laparoscopic transcystic common bile duct exploration(LTCBDE)and endoscopic retrograde cholangiopancreatography(ERCP)/endoscopicsphinctectoy(EST)+LC in patients with cholecystolithiasis with choledocholithiasis.Methods:The clinical data of 118 patients with cholecystolithiasis with choledocholithiasis treated from July 2021 to February 2024 were retrospectively collected,and they were divided into group A ( n =64) and group B ( n =54) according to different surgical methods.The former was treated with LC+LTCBDE,and the latter was treated with ERCP/EST+LC.The perioperative related indexes were compared between the two groups,as well as biochemical indexes [alkaline phosphatase (ALP),alanine aminotransferase (ALT),total bilirubin (TBIL),glutamyl transpeptidase (GGT)],inflammatory reaction[interleukin-10 (IL-10),substance P (SP),interleukin-8 (IL-8)] before and after operation,and complications were also compared between the two groups.Results:Compared with group B,group A had shorter hospitalization time,shorter drainage retention time,shorter first exhaust time,less hospitalization expenses,longer operation time and more bleeding ( P <0.05).Compared with group B,the levels of serum ALP,ALT,TBIL and GGT in group A were lower at 7 d after operation ( P <0.05).Compared with group B,the levels of serum SP and IL-8 were lower and the level of IL-10 was higher in group at 7 d after operation ( P <0.05).The incidence of complications in group A was lower than that in group B ( P <0.05).Conclusion:LC+LTCBDE for patients with gallstones and choledocholithiasis can improve biochemical indicators,reduce inflammatory reactions in the body,promote rapid recovery,and has good safety.

关 键 词：胆囊结石并胆总管结石 内镜逆行胆管造影 括约肌切开取石术 腹腔镜胆囊切除术 胆囊管胆总管探查取石术 

分 类 号：R575.6[医药卫生—消化系统]