腹腔镜联合ERCP对老年胆囊结石伴胆总管结石患者肝功能和血液粘度指标的影响观察

Effect of laparoscopy combined with ERCP on liver function and blood viscosity in elderly patients with cholecystolithiasis and choledocholithiasis

目的探究腹腔镜胆囊切除(LC)联合内镜下逆行胰胆管造影(ERCP)对老年胆囊结石伴胆总管结石患者肝功能、血液粘度指标的影响,为治疗该病症提供临床参考。方法回顾性分析成都上锦南府医院135例行微创手术治疗的胆囊结石伴胆总管结石老年患者临床资料,其中69例行ERCP+LC治疗(分步组),66例行LC+腹腔镜胆总管探查术(LCBDE)治疗(一步组)。记录比较2组患者的围术期相关指标及术后并发症发生情况,评估并比较2组手术前后肝功能指标、血液粘度指标、疼痛程度、胰腺损伤指标变化情况。结果2组取石成功率、术后并发症发生情况及术后1d的ALT、ALP及P、EAI比较,差异均无统计学意义(P>0.05);分步组的手术时间、术中出血量和术后排气时间均低于一步组(P<0.05),总住院时间多于一步组(P<0.05)。术后1d时,分步组VAS评分低于一步组(P<0.05),血清AMY水平高于一步组(P<0.05);但术后3 d时,2组VAS评分、血清AMY比较,差异无统计学意义(P>0.05)。结论ERCP+LC及LC+LCBDE疗效及安全性良好,但对术后早期肝功能及胰腺组织均能造成一定影响,其中ERCP+LC术式在术后恢复方面更具有优势。

Objective To explore the effects of laparoscopic cholecystectomy(LC)combinedwith endoscopic retrograde cholangiopancreatography(ERCP)on liver function and blood viscosity in elderly patients with cholecystolithiasis and choledocholithiasis,and provide clinical reference for the treatment of this disease.Methods The clinical data of 135 elderly patients with cholecystolithiasis and choledocholithiasis treated by minimally invasive surgery were analyzed retrospectively.Among them,69 cases were treated with ERCP+LC(step-by-step group),and 66 cases were treated with LC+LCBDE(one-step group).The perioperative related indexes and postoperative complications of the two groups were recorded.The liver function index,blood viscosity index,pain degree and pancreatic injury index before and after operation were compared between the two groups.Results Therewas no statistically significant difference in the success rate of stone retrieval,postoperative complications,and the levels of ALT,ALP,P,and EAI one day after operation between the two groups(P>0.05),but the operation time,intraoperative blood loss and postoperative exhaust time of step-by-step group were lower than those of one-step group(P<0.05),and the total hospitalization time was longer than that of one-step group(P<0.05).At one day after operation,VAS score of step-by-step group was lower than that of one-step group(P<0.05),and serum AMY level was higher than that of one-step group(P<0.05),but at 3 days after operation,there was no significant difference in VAS score and serum AMY between the two groups(P>0.05).Conclusion ERCP+LC and LC+LCBDE have good efficacy and safety,but they can affect the early postoperative liver function and pancreatic tissue,and ERCP+LC has more advantages in postoperative recovery.