不同胆总管取石术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的疗效比较

Comparison of Therapeutic Effects of Different Choledocholithotomy Combined with Laparoscopic Cholecystectomy for Cholecystolithiasis with Choledocholithiasis

目的探讨不同胆总管取石术联合腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石的临床疗效。方法选取2018年5月至2019年5月,重庆市大足区人民医院肝胆外科收治的胆囊结石合并胆总管结石患者110例,随机分为对照组和试验组,每组55例,对照组给予经腹腔镜胆总管切开取石术(LCBDE)联合LC(LCBDE+LC),试验组给予十二指肠镜下胆总管取石术(ERCP/EST)联合LC(ERCP/EST+LC)。比较两组炎症相关指标、围术期基本情况及术后并发症等情况。结果试验组术中出血量和术后下床时间、排气时间、白细胞介素6(IL-6)、C反应蛋白(CRP)、并发症发生率及住院时间明显低于对照组;但试验组手术时间、治疗费用明显高于对照组,差异有统计学意义(P<0.05);两组术后谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、淀粉酶(AMS)、手术成功率、结石清除率、复发率比较,差异无统计学意义(P>0.05)。结论两种术式均疗效明显,但试验组具有创伤小、并发症少、术后康复好等优点,对照组具有操作简单、治疗费用低等优点,应依据临床需求合理选择术式。

Objective To explore and compare the clinical effects of different choledocholithotomy combined with laparoscopic cholecystectomy(LC)in the treatment of cholecystolithiasis with choledocholithiasis.Methods A total of 110 patients with cholecystolithiasis combined with choledocholithiasis in the hepatobiliary surgery department of the People's Hospital of Dazu District of Chongqing from May 2018 to May 2019 were selected and randomly divided into control group and experimental group,with 55 cases in each group.The control group was given laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy(LCBDE+LC),while the experimental group was given endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy combined with laparoscopic cholecystectomy(ERCP/EST+LC).Inflammation related indexes,perioperative basic conditions and postoperative complications were compared between the two groups.Results The amount of intraoperative blood lose,time from surgery to ambulating,time from surgery to intestinal exhaust,postoperative interleukin-6(IL-6),C-reactive protein(CRP),incidence of complications and hospital stay in the experimental group were significantly lower than those in the control group,while the duration of operation and treatment cost of the experimental group were significantly higher than those of the control group,and the differences were statistically significant(P<0.05).Comparison of postoperative alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),amylase(AMS),surgery success rate,stone clearance rate,and recurrence rate between the two groups showed no significant difference(P>0.05).Conclusion Both surgical methods have obvious curative effects.The method for the experimental group has the advantages of less trauma,fewer complications and better postoperative recovery.And the method for the control group has the advantages of simple operation and low treatment cost.The surgical method should be selected reasonably according to clinical needs.