胆总管结石合并胆囊结石病人一期行内镜逆行胰胆管造影联合腹腔镜胆囊切除手术疗效分析  

Analysis of the therapeutic efficacy of one-stage endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy surgery in patients with common bile duct stones and gallbladder stones

作　　者：匡镜潮 杨康 张辉 高绪照 KUANG Jingchao;YANG Kang;ZHANG Hui;GAO Xuzhao(Hunan Normal University,Changsha 410000,China;不详)

机构地区：[1]湖南师范大学,长沙410000 [2]湖南省张家界市人民医院肝胆外科

出　　处：《临床外科杂志》2025年第3期299-302,共4页Journal of Clinical Surgery

摘　　要：目的评估胆总管结石并胆囊结石病人一期行内镜逆行胰胆管结石(ERCP)+腹腔镜胆囊切除术(LC)治疗的安全性与可行性。方法2023年1月~2024年8月间收治的胆总管结石合并胆囊结石的病人185例,将同一手术时段接受ERCP+LC的病人被分配到A组(94例),在同一住院期间分次接受LC+ERCP的病人被分配到B组(91例)。记录两组病人性别、年龄、总住院费用、结石数目及大小、是否留置引流管、术中失血量、麻醉持续时间、术后肠道排气时间、住院时间、术后胆管炎发生率、术后胰腺炎发生率、术后胆管残余结石率以及术前、术后的中性粒细胞、中性粒细胞百分比、总血清胆红素、间接血清胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰转移酶变化情况。结果B组住院时间为(9.7±2.0)天,A组为(8.6±2.6)天,两组比较差异有统计学意义(P<0.05)。A组病人的麻醉持续时间为(2.5±0.8)小时,B组为(3.7±0.5)小时,两组比较差异有统计学意义(P<0.05)。A组病人的总住院费用为(23969±7421)元,B组为(25427±5236)元,两组比较差异有统计学意义(P<0.05)。结论一期ERCP联合LC治疗胆总管结石合并胆囊结石的手术方案安全可行,住院时间短,费用少,麻醉持续时间短。Objective To evaluate the safety and feasibility of primary endoscopic retrograde cholangiopancreatolithiasis(ERCP)plus laparoscopic cholecystectomy(LC)in patients with choledocholithiasis combined with cholecystolithiasis.Methods From January 2023 to August 2024,185 patients with common bile duct stones combined with gallbladder stones were treated at our hospital.Patients who underwent ERCP+LC during the same surgical period were assigned to Group A(94 patients),and those who underwent LC+ERCP in separate sessions during the same hospital stay were assigned to Group B(91 patients).The gender,age,total hospitalization costs,number and size of stones,whether a drainage tube was left in place,intraoperative blood loss,duration of anesthesia,time to postoperative bowel gas passage,length of hospital stay,incidence of postoperative cholangitis,incidence of postoperative pancreatitis(PEP),rate of residual stones in the bile ducts,and changes in preoperative and postoperative neutrophils,neutrophil percentage,total serum bilirubin,indirect serum bilirubin,alanine aminotransferase,aspartate aminotransferase,and γ-glutamyl transferase were recorded for both groups of patients.Results Compared to Group B[(9.7±2.0)d],the hospital stay duration for patients in Group A[(8.6±2.6)d]was significantly reduced(P<0.05).The duration of anesthesia for patients in Group A[(2.5±0.8)h]was also significantly shorter than that for Group B[(3.7±0.5)h],with a statistically significant difference(P<0.05).Similarly,the total hospitalization costs for patients in Group A[(23969±7421)yuan]were lower than those for Group B[(25427±5236)yuan],and this difference was statistically significant(P<0.05).Conclusion The one-stage ERCP combined with LC treatment protocol for common bile duct stones with gallbladder stones is safe and feasible,with the potential advantages of reducing hospital stay,costs,and duration of anesthesia.

关 键 词：胆总管结石 胆囊结石 内镜逆行胰胆管造影 腹腔镜胆囊切除 手术治疗 

分 类 号：R65[医药卫生—外科学]