经内镜逆行胰胆管造影联合近、远期胆囊切除术对胆道结石疗效分析

Clinical curative effect of endoscopic retrograde cholangiopancreatography combined with recent or long-term laparoscopic cholecystectomy for biliary calculi

目的:探讨经内镜逆行胰胆管造影(ERCP)联合近、远期胆囊切除术对胆道结石疗效。方法:回顾性分析2013年3月至2015年3月河北省涉县医院收治的74例胆囊结石合并胆总管结石患者的临床资料,分为近期组37例和远期组37例,近期组患者于ERCP后3~7 d行腹腔镜胆囊切除术(LC),远期组患者于ERCP后1~3个月行LC,两组患者入院后均行ERCP,记录两组患者手术一般情况及术后并发症,比较两组患者胆囊切除前后直接胆红素(DBIL)、丙氨酸转氨酶(ALT)、血清淀粉酶(AMS)、胃肠激素变化水平。结果:两组患手术时间、术中出血量、术后引流量、中转开腹率等一般资料比较差异无统计学意义(P>0.05);胆囊切除前、切除第3天近期组DBIL、ALT、AMS均显著高于远期组(P<0.05),胆囊切除第7天两组患者DBIL、ALT、AMS比较差异无统计学意义(P>0.05);两组患者胆囊切除后血清胆囊收缩素(CCK)、血管活性肠肽(VIP)、胃蛋白酶原Ⅰ(PGⅠ)均呈先降低后上升趋势,至切除后第7天CKK、VIP、PGⅠ均恢复至正常水平;胆囊切除前、切除第3天近期组CKK、VIP、PGⅠ均显著低于远期组(P<0.05),胆囊切除第7天两组患者DBIL、ALT、AMS比较差异无统计学意义(P>0.05)。两组术后均未见严重并发症,两组胆漏、腹腔出血、术后黄疸、腹腔感染、胆管炎、轻度胰腺炎等并发症发生率比较差异无统计学意义(P>0.05);两组患者术后残留结石率、复发率比较差异亦无统计学意义(P>0.05)。结论:ERCP后近期内行LC,术后并发症发生率未见增加,且对脏器损伤及胃肠功能影响较小,只要掌握手术要点,该治疗模式是完全可行的。

Objective： To explore the the curative effect of endoscopic retrograde cholangiopancreatography （ERCP） combined with recent or long-term laparoscopic cholecystectomy（LC） ） for biliary calculi. Methods： 74 cases of gallbladder stones and common bile duct stones patients were divided into recent group （37 cases） and long-term group （37 cases）, the patients in recent group underwent LC after 3-7 d of ERCP, long-term underwent LC after 1-3 month of ERCP. Paitents in the two groups were perfomed ERCP after admission, the general operation and postoperative complications of the two groups were recorded ; the direct bilirubin （DBIL） , alanineaminotransferase（ALT）, amylase （AMS） and gastrointestinal hormone changes were compared between the two groups before and after cholecystectomy. Results： There was no significant difference between the two groups in the operation time, blood loss, postoperative drainage volume, conversion rate, and other general information （P 〉 0.05 ）. Before and after 3 d of cholecystectomy the DBIL, ALT, AMS in recent group were significantly higher than those in long-term group（P 〈0.05） ,and after 7 d of cholecystectomy there was no significant difference in DBIL, ALT, AMS between the two groups （ P 〉 0. 05 ）. After cholecystectomy, the gallbladder serum cholecystokinin （CCK）, vasoactive intestinal peptide（VIP）, pepsinogen I （PGI） in the two groups showed a decreased trend, and then increased,to 7 d after cholecystectomy the CKK, VIP, PG I in the two groups were returned to normal levels. Before and after 3 d of cholecystectomy the CKK, VIP, PG I in recent group was significantly higher than those in long- term group （ P 〈 0.05 ）, and after 7 d of cholecystectomy there was no significant difference in CKK, VIP, PG I between two groups （P 〉 O. 05 ）. There was no severe complications in the two groups after operation, the incidence of bile leakage, abdominal bleeding, postoperative jaundice, abdominal infection, cholangitis, mild pancreatitis had no statistically significant between the two groups （ P 〉 O. 05 ）. There was also no significant difference in esidual stone rate and recurrence rate between the two groups （ P 〉 0.05 ）. Conclusion： The incidence rate is fower for endoscopic retrograde cholangiopancreatography combined with recent laparoscopic cholecystectomy, and with less influence on the organ damage and gastrointestinal function. This treatment model is completely feasible as long as master the key points of operation.