ERCP/EST治疗胆囊结石合并胆总管结石的临床价值研究

Clinical value of ERCP/EST in the treatment of cholecystolithiasis complicated with common bile duct stones

目的探讨内窥镜逆行胰胆管造影(ERCP)/十二指肠乳突肌切开术(EST)治疗胆囊结石合并胆总管结石的临床价值。方法回顾性选取2016年1月至2019年1月于西南医科大学附属医院就诊的胆囊结石合并胆总管结石患者100例,按治疗方法分组,观察组患者采取ERCP/EST+LC进行治疗,对照组采取腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查取石术(LCBDE)进行治疗。比较两组的临床效果,术中及术后基本情况,术后24 h时肝功能指标,术后6个月后并发症发生情况。结果观察组的结石清除率(98.00%)显著高于对照组(88.00%),结石残留率(4.00%)显著低于对照组(14.00%),差异均有统计学意义(P<0.05)。两组在中转开腹的比较中,差异无统计学意义(P>0.05)。观察组的手术时间(80.32±12.15)min,显著长于对照组的(62.45±11.06)min,治疗费用(49876.47±2503.58)元,显著高于对照组的(34012.81±3463.09)元,差异均有统计学意义(P<0.05)。两组住院时间、手术出血量的比较差异无统计学意义(P>0.05)。术后24 h时观察组AST、ALT和ALP的改善程度明显优于对照组(P<0.05)。两组术后6个月的并发症总发生率比较差异无统计学意义(P>0.05)。结论ERCP/EST治疗胆囊结石合并胆总管结石能够显著提高结石的清除率,降低结石残留率,创伤小,安全性高,利于患者术后恢复,并且术后并发症的发生率较低,值得临床参考。

Objective To explore the clinical value of endoscopic retrograde cholangiopancreatography/myotomy of duodenum and mastoid in the treatment of cholelithiasis with choledocholithiasis.Methods From January 2016 to January 2019,100 patients with gallstone and choledocholithiasis in our hospital were divided into observation group and control group,with 50 cases in each group.The observation group was treated with ERCP/DMM+LC,and the control group was treated with LC+LCBDE.The clinical effects and basic situation of the two groups were compared during and after operation.Liver function indexes between the two groups were compared after 24 hours of operation.The complications of the two groups were compared after operation.Results The stone removal rate(98.00%)of the observation group was significantly higher than that of the control group(88.00%),the stone residual rate(4.00%)was significantly lower than that of the control group(14.00%),the difference was statistically significant(P<0.05);there was no significant difference between the two groups in the conversion to open surgery(P>0.05);the operation time of the observation group was significantly longer than that of the control group(80.32±12.15).The difference was statistically significant(P<0.05).There was no significant difference between the two groups in the comparison of the length of stay and the amount of bleeding during operation(P>0.05).After 24 hours of operation,the improvement of AST,ALT and ALP in the observation group was significantly better than that in the control group(P<0.05).There was no significant difference between the two groups in the comparison of the total incidence of postoperative complications(P>0.05).Conclusion ERCP/EST treatment of choledocholithiasis with choledocholithiasis can significantly improve the stone clearance rate,reduce the stone residual rate,with small trauma and high safety,which is conducive to the postoperative recovery of patients,and the incidence of postoperative complications is low,which is worthy of clinical reference.