不同微创手术治疗老年胆囊结石合并胆总管结石的有效性及对肝功能的影响

The effectiveness of different minimally invasive surgeries in the treatment of elderly patients with gallbladder stones and common bile duct stones and their impact on liver function

目的对比不同微创手术治疗老年胆囊结石(GD)合并胆总管结石(CBDS)患者的效果。方法回顾性收集我院92例老年GD合并CBDS患者病例资料(2020年1月~2021年10月),以接受腹腔镜胆囊切除术(LC)联合经内镜逆行胰胆管造影术(ERCP)/经内镜十二指肠乳头括约肌切开取石术(EST)治疗的46例患者为LC+ERCP/EST组,以接受LC联合胆总管探查术(LCBDE)治疗的46例患者为LC+LCBDE组。对比2组围术期指标、手术成功率、结石清除率及术后并发症发生率、手术前后肝功能指标。结果LC+ERCP/EST组住院时间和费用均高于LC+LCBDE组,全麻用时较LC+LCBDE组短(P<0.05);两组手术成功率、结石清除率和并发症总发生率比较无明显差异(P>0.05);术后3d、5d 2组血清总胆红素(TBIL)、谷丙转氨酶(ALT)、结合胆红素(DBIL)、天门冬氨酸氨基转移酶(AST)水平均较术前降低(P<0.05),但两组组间相比明显差异(P>0.05)。结论LC+ERCP/EST与LC+LCBDE治疗老年GD合并CBDS患者结石清除效果相当,但前者全麻用时短,后者住院耗时短,治疗费用低。

Objective To compare the effectiveness of different minimally invasive surgeries in the treatment of elderly patients with gallbladder stones(GD)and common bile duct stones(CBDS).Methods A retrospective collection of 92 elderly patients with GD and CBDS in our hospital(January 2020 to October 2021)was conducted.Among them,46 patients who received laparoscopic cholecystectomy(LC)combined with endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic duodenal papillary sphincter lithotomy(EST)were included in the LC+ERCP/EST group,and 46 patients who received LC combined with common bile duct exploration(LCBDE)were included in the LC+LCBDE group.The perioperative indicators,surgical success rate,stone clearance rate,postoperative complication rate,and liver function indicators before and after operation were compared between the two groups.Results The hospitalization time and hospitalization expenses of the LC+ERCP/EST group were higher than those of the LC+LCBDE group,and the total anesthesia time was shorter than that of the LC+LCBDE group(P<0.05).There were no significant differences in surgical success rate,stone clearance rate and total complication rate between the two groups(P>0.05).The serum levels of TBIL,ALT,AST,DBIL,and AST in both groups decreased compared to before surgery on the 3rd and 5th postoperative days(P<0.05).However,there were significant differences between the two groups(P>0.05).Conclusion LC combined with ERCP/EST and LC combined with LCBDE have similar stone clearance effects in the treatment of elderly GD patients with CBDS.However,the former has shorter general anesthesia time,while the latter has shorter hospitalization time and lower treatment costs.