ERCP与EST联用对急性胆囊结石合并胆总管结石的手术效果及预后康复影响分析  

Analysis of the surgical effect and prognostic rehabilitation impact of ERCP combined with EST on acute gallstones with common bile duct stones

作　　者：孙晓光[1] 任长安[1] 季世强[2] 高建国[1] 杜金龙[1] 白旭宝 SUN Xiaoguang;REN Chang'an;JI Shiqiang;GAO Jianguo;DU Jinlong;BAI Xubao(Department of Emergency,Chengde Central Hospital,Chengde Hebei 067000,China)

机构地区：[1]承德市中心医院急诊科,河北承德067000 [2]承德市中心医院普外科,河北承德067000

出　　处：《中国急救复苏与灾害医学杂志》2025年第4期480-483,488,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：承德市科技支撑项目(202305B012)。

摘　　要：目的 探讨内窥镜逆行胰胆管造影术(ERCP)与十二指肠乳头括约肌切开术(EST)联用对急性胆囊结石(GS)合并胆总管结石(CBDS)的手术效果及预后康复影响。方法 回顾性分析承德市中心医院2022年3月—2023年2月急诊科收治的120例GS合并CBDS患者的临床资料,根据不同手术方案分为对照组59例、观察组61例。对照组给予腹腔镜治疗[腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查取石术(LCBDE)],观察组给予ERCP与EST联合治疗。对比两组的手术效果及预后康复、手术前后1 d肝功能指标、炎症及应激指标;随访术后1个月,对比两组的安全性。结果 观察组的手术时间、术中出血量高于对照组(t=5.625、5.066,均P<0.05),而两组术后1周的结石清除率、术后排气、胃肠恢复及住院时间、医疗费用组间对比,差异无统计学意义(P>0.05)。两组术后总胆红素(TBIL)、碱性磷酸酶(ALP)、谷丙转氨酶(GPT)水平均较术前升高(P<0.05),而术前、术后两组上述肝功能指标组间对比,差异无统计学意义(P>0.05)。两组的术后肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、皮质醇(Cor)、肾上腺素(EPI)水平均较术前升高(P<0.05),而术前、术后两组上述炎症及应激指标组间对比,差异无统计学意义(P>0.05)。观察组胰腺炎发生率高于对照组,胆漏发生率低于对照组(χ^(2)=6.696、6.530,均P<0.05);而两组术后穿孔、出血及总并发症发生率对比,差异无统计学意义(P>0.05)。结论 与常规腹腔镜手术(LC+LCBDE)比较,ERCP与EST联用治疗GS合并CBDS患者疗效相当,二者各有优劣势,临床应根据风险获益及患者意愿合理决策。ObjectiveTo explore the surgical effect and prognostic rehabilitation impact of endoscopic retrograde cholangiopancreatography(ERCP) combined with endoscopic sphincterotomy(EST) on acute gallstone(GS)complicated with common bile duct stones(CBDS).MethodsA retrospective analysis was conducted on the clinical data of 120 patients with GS combined with CBDS admitted to the emergency department of Chengde Central Hospital from March 2022 to February 2023.According to different surgical plans,they were divided into a control group of 59cases and an observation group of 61 cases.The control group received laparoscopic treatment [laparoscopic cholecystectomy(LC)+ laparoscopic common bile duct exploration(LCBDE)],while the observation group received a combination of ERCP and EST treatment.Compare the surgical outcomes,prognosis,recovery,liver function indicators,inflammation and stress indicators before and after surgery between two groups;follow up for one month after surgery and compare the safety of the two groups.ResultsThe observation group had higher surgical time and intraoperative blood output than the control group(t=5.625,5.066,all P<0.05),while there was no statistical significance in stone clearance rate,postoperative exhaust,gastrointestinal recovery,hospitalization time,and medical expenses between the two groups one week after surgery(P>0.05).The levels of total bilirubin(TBIL),alkaline phosphatase(ALP),and glutamic pyruvic transaminase(GPT) in both groups increased after surgery compared to preoperative levels,while there was no statistical significance in the above liver function indicators between the preoperative and postoperative groups(P>0.05).The levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),cortisol(Cor),and epinephrine(EPI) in both postoperative groups increased compared to preoperative levels,while there was no statistical significance in the above inflammatory and stress indicators between the preoperative and postoperative groups(P>0.05).The incidence of pancreatitis in the

关 键 词：急性胆囊结石 胆总管结石 内窥镜逆行胰胆管造影术 十二指肠乳头括约肌切开术 康复 

分 类 号：R575.62[医药卫生—消化系统]