腹腔镜联合经内镜逆行性胰胆管造影术治疗胆总管结石的疗效观察

Curative Efficacy of Laparoscopic Combined with Endoscopic Retrograde Cholangiopancreatography in the Treatment of Choledocholithiasis

目的:探讨腹腔镜联合经内镜逆行性胰胆管造影术治疗胆总管结石的临床疗效及安全性。方法:选择2016年1月到2019年1月我院收治的胆总管结石患者350例为研究对象,根据手术方法将其分为观察组(n=176)和对照组(n=174)。对照组给予腹腔镜胆囊切除、胆总管切开取石术,观察组给予腹腔镜联合经内镜逆行性胰胆管造影术治疗。比较两组患者的手术情况、治疗前后总胆汁酸(TBA)、总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(γ-GT)水平的变化、胃肠功能恢复情况及并发症的发生情况。结果:观察组手术时间明显长于对照组(P<0.05),术中出血量、术后下床时间及住院时间均显著低于对照组(P<0.05)。两组治疗后血清TBA、TBil、DBil、IBil、AST、ALT及γ-GT水平均较治疗前显著改善,且观察组血清以上指标水平均显著低于对照组(P<0.05)。观察组肠鸣音恢复时间、排气时间及排便时间均明显短于对照组(P<0.05)。治疗期间,两组并发症总发生率为1.70%、13.22%,观察组显著低于对照组(P<0.05)。结论:腹腔镜联合经内镜逆行性胰胆管造影术治疗胆总管结石患者的临床效果显著优于腹腔镜胆囊切除、胆总管切开取石术,其可有效缩短患者住院时间,改善其肝功能,且安全性较高。

Objective:To study the curative efficacy of Laparoscopic combined with endoscopic retrograde cholangiopancreatography in the treatment of choledocholithiasis.Methods:350 patients with choledocholithiasis admitted to our hospital from January 2016 to January 2019 were selected and divided into the observation group(n=176)and the control group(n=174)according to surgical methods.The control group was treated with laparoscopic cholecystectomy,while the observation group was treated with laparoscopic combined with endoscopic retrograde cholangiopancreatography.The changes of total bile acid(TBA),total bilirubin(TBil),direct bilirubin(DBil),indirect bilirubin(IBil),AST,ALT,and kid-gt before and after treatment,the recovery of gastrointestinal function and the occurrence of complications in the two groups were compared.Results:The operation time of observation group was significantly longer than that of the control group(P<0.05),and the intraoperative blood loss,postoperative bed-out time and hospital stay were significantly lower than those in the control group(P<0.05).After treatment,the serum levels of TBA,TBil,DBil,IBil,AST,ALT and il-gt in the two groups were significantly improved compared with those before treatment,which were significantly lower in the observation group than those in the control group(P<0.05).The recovery time,exhaust time and defecation time in the observation group were significantly shorter than those in the control group(P<0.05).During the treatment period,the total incidence of complications in the two groups was 1.70%and 13.22%,which were significantly lower in the observation group than in the control group(P<0.05).Conclusion:Laparoscopic combined with endoscopic retrograde cholangiopancreatography is significantly better than laparoscopic cholecystectomy in the treatment of choledocholithiasis,which can effectively shorten the hospital stay of patients,improve their liver function with higher safety.