EST术后LC治疗胆总管结石并胆囊结石手术时机的相关研究

Study on the operative time of choledocholithiasis treated with LC after EST

目的研究胆总管结石并胆囊结石患者内镜下括约肌切开术(EST)后不同时期予以腹腔镜胆囊切除术(LC)的临床疗效。方法纳入2016年7月至2019年7月我院收治的165例胆总管结石并胆囊结石患者为对象,均先行EST后择期行LC。按两种术式间隔时间分为观察组(EST后48~72 h内行LC,82例)和对照组(EST后72 h后行LC,83例)。观察LC手术时间、LC术中出血量、住院总时间、LC术后肛门排气时间,分析两组中转开腹率及术后并发症发生状况,并比较两组标本切片中性粒细胞计数差异。结果观察组LC手术时间、LC术中出血量、住院总时间、LC术后肛门排气时间显著短于对照组(P<0.05)。观察组中转开腹率为3.66%,显著低于对照组的14.46%(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。观察组标本切片胆囊壶腹区中性粒细胞计数显著低于对照组(P<0.05)。结论胆总管结石并胆囊结石患者EST后48~72h内行LC安全可行,能缩短手术时间,减少术中出血,降低中转开腹率。

Objective To study the clinical effect of laparoscopic cholecystectomy(LC)at different stages after endoscopic sphincterotomy(EST)in patients with choledocholithiasis and cholecystolithiasis.Methods From July 2016 to July 2019,165 patients with choledocholithiasis and cholecystolithiasis were enrolled in this study.All patients underwent EST before LC.According to the interval time between the two methods,the patients were divided into observation group(LC within 48-72 hours after EST,82 cases)and control group(LC after 72 hours after EST,83 cases).The operation time,bleeding volume during LC,total hospital stay and anal exhaust time after LC were observed.The conversion rate to laparotomy and the occurrence of complications were analyzed.The differences of neutrophil counts between the two groups were compared.Results The time of LC operation,the amount of bleeding during LC operation,the total time of hospitalization and the time of anal exhaust after LC operation in the observation group were significantly shorter than those in the control group(P<0.05).The rate of conversion to laparotomy in the observation group was 3.66%,significantly lower than 14.46%in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The number of neutrophils in gallbladder ampulla of observation group was significantly lower than that of control group(P<0.05).Conclusion LC is safe and feasible for patients with choledocholithiasis and cholecystolithiasis within 48-72 hours after EST.It can shorten the operation time,reduce intraoperative bleeding and reduce the conversion rate to laparotomy.