胆总管结石并胆囊结石患者内镜逆行胰胆管造影术后行腹腔镜胆囊切除术的时间选择分析

Analysis of the time selection of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in patients with choledocholithiasis and gallbladder stones

目的分析胆总管结石合并胆囊结石患者内镜逆行胰胆管造影(ERCP)术后不同时间行腹腔镜胆囊切除术(LC)治疗的临床效果。方法选择2018年2月至2019年12月白山市中心医院收治的80例胆总管结石并胆囊结石患者作为研究对象,根据随机数字表法分成对照组和观察组,各40例,均行ERCP术治疗,对照组患者于ERCP术后4~15 d行LC治疗,观察组患者于ERCP术后1~3 d行LC治疗,两组患者均于术后随访7 d。比较两组患者术后7 d临床疗效,手术相关临床指标,术前与术后7 d血清肝功能、炎性因子指标,术后7 d结石清除率与并发症发生情况。结果术后7 d观察组患者临床总有效率显著高于对照组;观察组患者术中出血量显著少于对照组,手术时间和住院时间均显著短于对照组;与术前比,术后3 d两组患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、总胆红素(TBiL)及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平均显著降低,且观察组显著低于对照组;而白细胞介素-10(IL-10)水平显著升高,且观察组显著高于对照组(均P<0.05);术后7 d观察组患者并发生总发生率、结石清除率均低于对照组,但组间比较,差异均无统计学意义(均P>0.05)。结论胆总管结石合并胆囊结石患者ERCP术后早期行LC治疗,可更有效减少患者术中出血量,缩短住院时间,有效保护机体肝功能,降低炎性应激反应,改善患者预后。

Objective To analyze the clinical effects of laparoscopic cholecystectomy(LC) at different times after endoscopic retrograde cholangiopancreatography(ERCP) in patients with choledocholithiasis and gallbladder stones. Methods A total of 80 cases patients with choledocholithiasis and gallbladder stones admitted to Baishan Central Hospital from February 2018 to December 2019 were selected and acted as the research objects, they were divided into the control group and the observation group according to the random number table method,each with 40 cases, all were treated with ERCP, patients in the control group received LC treatment 4~15 days after ERCP, while patients in the observation group received LC treatment 1~3 days after ERCP, and both groups were followed up for 7 days afteroperation. The clinical curative effect 7 days after operation, surgical-related clinical indicators, serum liver function, inflammatory factor indicators before and 7 days after operation, stone clearance rate and complications occurrence 7 days after operation of patients in the two groups were compared between the two groups. Results The total clinical effective rate of the observation group was significantly higher than that of the control group 7 days after operation;the intraoperative blood loss of patients in the observation group was significantly less than that in the control group,and the operation time and hospital stay were significantly shorter than those of the control group;compared with before operation, the serum alanine aminotransferase(ALT), aspartate aminotransferase(AST), γ-glutamyl transpeptidase(GGT), and total bilirubin(TBiL) and serum tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), C-reactive protein(CRP) levels of patients in the two groups 3 days after operation reduced significantly, and the observation group was significantly lower than the control group;but the level of interleukin-10(IL-10) increased significantly, and the observation group was significantly higher than the control group(all P<0.05);the total incidence and stone clearance rate of patients in the observation group 7 days after operation, were lower than those of the control group, but there were no statistically significant difference between the two groups(all P>0.05). Conclusion Early LC treatment for patients with choledocholithiasis and gallbladder stones after ERCP can more effectively reduce the patients’ intraoperative blood loss, shorten the hospital stay, effectively protect the body’s liver function, and reduce inflammatory stress.