腹腔镜下胆囊切除术联合经腹顺行导丝引导逆行胰胆管造影术取石治疗胆囊结石合并细径胆总管结石的疗效分析

Clinical application of laparoscopic cholecystectomy combined with transabdominal anterograde guided Endoscopic Retrograde Cholangiopancretography in the treatment of cholecystolithiasis complicated with small diameter choledocholithiasis

目的探讨腹腔镜下胆囊切除术(laparoscopic cholecystectomy, LC)联合经腹顺行导丝引导经内镜逆行胰胆管造影术(ERCP)取石治疗胆囊结石合并细径胆总管结石的临床疗效。方法 2017年1月~2018年12月间我院收治的胆囊结石合并细径胆总管结石病人80例,按照随机数字表法分为对照组与观察组,每组各40例。观察组采用LC+顺行导丝引导ERCP取石术治疗,对照组采用ERCP+LC治疗。比较两组手术情况,术后并发症,结石残留情况、术前和术后3天肝功能、术前及术后7天的疼痛程度、术前及术后3个月的生活质量。结果与对照组比较,观察组术中出血量、肛门排气时间、胃肠功能恢复时间、引流管放置时间、住院时间均明显减少,差异有统计学意义(P<0.05),两组结石残留率比较,差异无统计学意义;术后3天,两组血清丙氨酸氨基转移酶(ALT)、天门冬氨酸转氨酶(AST)和总胆红素(TB)水平较术前明显降低,差异有统计学意义;组间比较差异无统计学意义;与对照组比较,观察组视觉模拟评分(visual analogue scale, VAS)Ⅰ级、Ⅱ级和Ⅲ~Ⅳ级均明显降低,生活满意度、健康指数和情感得分较对照组改善,差异有统计学意义(P<0.05)。结论 LC联合经腹顺行导丝引导ERCP治疗胆囊结石合并细径胆总管结石的临床效果良好,术后并发症较少,对肝功能影响小,生活质量明显改善。

Objective To investigate the clinical application of laparoscopic cholecystectomy(LC) combined with transabdominal anterograde guided endoscopic retrograde cholangiopancreatography(CP) in the treatment of cholecystolithiasis with small diameter choledocholithiasis.Methods The 80 patients with cholecystolithiasis and small diameter choledocholithiasis admitted to our hospital from January 2017 to December 2018 were divided into the control group(40 cases) and the observation group(40 cases) according to random number table method.The observation group was treated with LC and transabdominal anterograde guided Endoscopic Retrograde Cholangiopancretography, while the control group was treated with oral CP+ LC.The operation conditions, postoperative complications, residual stones, liver function at 3 days before and after operation, pain levels before and 7 days after operation, and quality of life before and 3 months after operation were compared between 2 groups.Results Compared with the control group, the observation group’s intraoperative blood loss, anal exhaust time, gastrointestinal function recovery time, drainage tube placement time, and hospital stay were significantly reduced(P<0.05),there was no statistical difference in the residual rate of stones.After operation, there was no significant difference in the changes of serum ALT,AST and TB levels between 2 groups(P>0.05).3 days after operation, the serum ALT,AST and TB levels, VAS Ⅰ,Ⅱ grade Ⅲ and grade Ⅳ were significantly reduced(P<0.05),and life satisfaction, health index and emotional scores were significantly reduced(all P<0.05).Conclusion LC combined with transabdominal anterograde guided ERCP has good clinical effect in the treatment of cholecystolithiasis with small diameter choledocholithiasis, fewer complications, improve quality of life, which is worthy of clinical recommendation.