经内镜逆行胰胆管造影联合腹腔镜手术治疗胆总管结石伴胆囊结石的临床疗效观察

The clinical study of endoscopic retrograde cholangiopancreatography combined with laparoscopy for the treatment of common bile duct stones with gallstones

目的探讨经内镜逆行胰胆管造影联合腹腔镜手术治疗胆总管结石伴胆囊结石的临床疗效及安全性。方法选择2016年10月至2017年2月本院收治的胆总管结石伴胆囊结石患者138例,随机分为对照组(69例)和研究组(69例),对照组采用开腹胆囊切除术进行治疗,研究组采用经内镜逆行胰胆管造影联合腹腔镜手术进行治疗。观察两组患者的手术状况、临床疗效及术后不良反应,并检测术后血清总胆红素(total bilirubin,TBil)、C反应蛋白(C-reactive protein,CRP)和尿胰蛋白酶原-2水平。结果研究组切口大小、术中出血量、手术时间、术后排气时间和住院时间分别为(2.86±0.79)cm、(42.33±9.86)ml、(71.73±10.24)分钟、(18.93±2.54)小时和(9.47±1.65)天,对照组分别为(6.92±1.03)cm、(75.21±10.17)ml、(98.46±11.58)分钟、(27.61±2.85)小时和(14.39±2.07)天,研究组均低于对照组,差异有显著性(P<0.05)。研究组患者术后应用镇痛剂比例、术后并发症及残余结石发生率分别为13.04%(9/69)、2.90%(2/69),对照组分别为63.77%(44/69)、10.14%(7/69),研究组均低于对照组,差异有显著性(P<0.05)。研究组术后血清TBil、CRP和尿胰蛋白酶原-2水平分别为(62.40±18.37)μmol/L、(247.39±26.15)mg/L和(30.61±6.44)ng/ml,对照组分别为(74.56±16.28)μmol/L、(316.74±29.61)mg/L和(41.98±7.35)ng/ml,研究组均低于对照组,差异有显著性(P<0.05)。结论经内镜逆行胰胆管造影联合腹腔镜手术治疗胆总管结石伴胆囊结石能够有效清除结石,具有创伤小、并发症少、术后恢复快等优点,值得临床推广。

Objective To explore the operation efficacy and safety of endoscopic retrograde cholangiopancreatography combined with laparoscopic treat for common bile duct stones with gallstones. Method 138 patients with common bile duct stones with gallstones were selected from October in 2016 to February in 2017,and they were randomly divided into control group（69 cases） and study group（69 cases）. The patients in the control group were treated by open cholecystectomy. The patients of study group treated by endoscopic retrograde cholangiopancreatography combined with laparoscopic surgery. Mainly observed the two groups of patients with surgical conditions, clinical efficacy and postoperative adverse reactions, and detection of postoperative serum total bilirubin（TBil）, urinary trypsinogen-2 and C-reactive protein（CRP） levels. Result The average intraoperative blood loss incision size, intraoperative blood loss, operation time, postoperative exhaust time and hospital stay time of study group were（2.86±0.79）cm,（42.33±9.86） ml,（71.73±10.24） min,（18.93±2.54） h and（9.47±1.65） d, which were lower than those of the control group（6.92±1.03） cm（75.21±10.17） ml,（98.46 ± 11.58） min,（27.61±2.85） h and（14.39±2.07） d, the difference was statistically significant（P〈0.05）. The rate of analgesics, postoperative complications and residual stones of the study group were 13.04%（9/69） and 2.90%（2/69） respectively, which were lower than those of the control group（63.77%（44/69） and 10.14% 7/69）, the difference was statistically significant（P〈0.05）. The levels of TBil, urinary trypsinogen-2 and CRP were（62.40 ± 18.37） μmol/L,（30.61±6.44） ng/ml and（247.39±26.15） mg/L respectively, which were lower than those of the control group（74.56±16.28） μmol/L,（36.98±7.35） ng/ml and（316.74±29.61） mg/L, the difference was statistically significant（P〈0.05）. Conclusion Endoscopic retrograde cholangiopancreatography combined with laparoscopic treatment of common bile duct stones with gallstones can effectively remove stones, and it has advantages with less trauma, fewer complications, faster recovery. It is worthy of clinical application.