ERCP/LCBDE治疗胆总管结石疗效比较  

Comparison of the efficacy of ERCP/LCBDE in the treatment of common bile duct stones

作　　者：吴正东 徐刚[1] 慕海峰[1] 班坤锋 陈升宝[1] 王保臣 WU Zhengdong;XU Gang;MU Haifeng(Department of General Surgery,Nanjing Tongren Hospital Affiliated to Southeast University School of Medicine,Nanjing 222200,Jiangsu)

机构地区：[1]东南大学医学院附属南京同仁医院普外科,南京222200

出　　处：《肝胆外科杂志》2024年第5期342-346,共5页Journal of Hepatobiliary Surgery

摘　　要：目的比较经内镜逆行胰胆管造影术(ERCP)取石与腹腔镜胆管切开取石(LCBDE)治疗胆总管结石的疗效。方法回顾性分析2022年5月至2024年3月本院收治的79例老年胆总管结石患者的资料,按采取术式的不同分成ERCP组(n=38,实施ERCP取石)和LCBDE组(n=41,实施LCBDE)。比较两组手术指标、术后疼痛度、肝功能指标[谷草转氨酶(AST)、总胆红素(TBil)]变化及术后并发症情况。结果LCBDE组取石成功率和ERCP组比较无统计学差异(P>0.05),手术用时、术中失血量多于ERCP组(P<0.05),首次排气时间、首次排便时间及住院天数和ERCP组相比均更短(P<0.05)。LCBDE组术后6h、1d及3d数字评价量表(NRS)评分和ERCP组比较无统计学差异(P>0.05)。术后3d,两组AST、TBIL水平均低于术前(P<0.05),组间2项肝功能指标水平比较无统计学差异(P>0.05)。LCBDE组术后并发症发生率(9.76%比15.79%)和ERCP组比较无统计学差异(P>0.05)。结论ERCP取石和LCBDE治疗老年胆总管结石患者的效果相当,均可有效清除结石,促进肝功能恢复。但LCBDE在缩短恢复时间方面更具优势。Objective:To compare the efficacy of endoscopic retrograde cholangiopancreatography(ERCP)stone removal and laparoscopic common bile duct exploration(LCBDE)in the treatment of common bile duct stones.Methods The data of 79 elderly patients with choledocholithiasis admitted to our hospital from May 2022 to March 2024 were retrospectively analyzed,and divided into the ERCP group(n=38,ERCP stone removal was performed)and the LCBDE group(n=41,LCBDE was performed)according to the difference of the surgical methods adopted.The two groups were compared in terms of surgical indexes,postoperative pain,changes in liver function indexes[aminotransferase(AST),total bilirubin(TBil)] and postoperative complications.Results There were no statistically obvious differences in success rate of stone resection between LCBDE group and ERCP group(P>0.05).The operation time and intraoperative blood loss in the LCBDE group were higher than those in the ERCP group(P<O.05).The time to first ex-haust,time to first defecation and length of hospital stay in LCBDE group were shorter than those in the ERCP group(P<0.05).There was no obvious difference between the LCBDE group and the ERCP group in numerical rating scale postoperative 6 h,1 d,and 3 d(P>0.05).On the 3 d day after surgery,the levels of AST and TBIL in the two groups were lower than those before operation(P<0.05),and there was no obvious difference in the levels of liver function indexes between the two groups(P>0.05).There was no obvious difference in the incidence of postoperative complications between the LCBDE group and the ERCP group(9.76%vs.15.79%)(P>0.05).Conclusion ERCP stone removal and LCBDE have comparable effects in the treatment of elderly patients with common bile duct stones,and both can effectively remove stones and promote the recovery of liver function.But LCBDE has an advantage in terms of reducing recovery time.

关 键 词：内镜逆行胰胆管造影术 腹腔镜胆管切开取石 胆总管结石 疼痛度 肝功能 

分 类 号：R659[医药卫生—外科学]