腹腔镜胆囊切除术联合腹腔镜胆总管探查术治疗胆囊及肝外胆管结石并发轻症急性胆源性胰腺炎的临床效果

Clinical effect of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration in the treatment of gallbladder and extrahepatic bile duct stones complicated with mild acute biliary pancreatitis

目的探讨腹腔镜胆囊切除术联合腹腔镜胆总管探查术(LC+LCBDE)治疗胆囊及肝外胆管结石并发轻症急性胆源性胰腺炎的临床效果。方法选取2017年1月至2020年12月廉江市人民医院收治的88例胆囊及肝外胆管结石并发轻症急性胆源性胰腺炎患者作为研究对象,采用掷硬币法分为开腹组(46例)与腔镜组(42例),开腹组采用开腹胆囊切除术联合开腹胆总管探查术(OC+OCBDE),腔镜组采用LC+LCBDE治疗。比较两组患者手术治疗相关指标(手术时间、术中出血量、一次性结石清除率、术后首次肛门排气时间、进食时间、住院时间)、手术前后的血清学指标[谷草转氨酶(AST)、谷氨酸-丙酮酸转氨酶(ALT)、总胆红素(TBil)、血清淀粉酶(AMS)]水平、住院期间不良反应(胆漏、胆管炎、创口感染、胆道出血、胰腺坏死)总发生率。结果腔镜组的术中出血量少于开腹组,腔镜组的术后首次肛门排气时间、进食时间及住院时间短于开腹组,腔镜组住院期间的不良反应总发生率低于开腹组,差异有统计学意义(P<0.05)。两组患者的手术时间、一次性结石清除率以及术后7 d的AST、ALT、TBil、AMS水平比较,差异无统计学意义(P>0.05)。结论对于胆囊及肝外胆管结石并发轻症急性胆源性胰腺炎患者,OC+OCBDE及LC+LCBDE均能有效切除病变胆囊、清除肝外胆管结石,改善肝功能,控制胰腺炎症,但与OC+OCBDE比较,LC+LCBDE具有出血量少、胃肠功能恢复快、并发症少、痛苦少、恢复快的优点,能促进快速康复,是值得临床推广的微创手术方式。

Objective To investigate the clinical effect of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration(LC+LCBDE)in the treatment of gallbladder and extrahepatic bile duct stones complicated with mild acute biliary pancreatitis.Methods A total of 88 patients with gallbladder and extrahepatic bile duct stones complicated with mild acute biliary pancreatitis admitted to Lianjiang People′s Hospital from January 2017 to December 2020 were selected as the research subjects.They were divided into the open group(46 cases)and the endoscopic group(42 cases)according to coin tossing method.The open group was treated with open cholecystectomy combined with open common bile duct exploration(OC+OCBDE).The endoscopic group was treated with LC+LCBDE.Compare the surgery related indicators(operation time,intraoperative blood loss,disposable stone clearance rate,postoperative anal exhaust time,feeding time,the length of hospital stay),the serological indexes(aspertate aminotransferase[AST],glutamate pyruvate transaminase[ALT],total bilirubin[TBil],serum amylase[AMS])level before and after surgery,total incidence of adverse reactions during hospitalization(biliary leakage,cholangitis,wound infection,biliary hemorrhage,pancreatic necrosis)of two groups.Results The intraoperative blood loss in the endoscopic group was less than that in the open group,the first postoperative anal exhaust time,eating time and hospital stay in the endoscopic group were shorter than those in the open group,and the total incidence of adverse reactions in the endoscopic group was lower than that in the open group,the differences were statistically significance(P<0.05).There were no stastically significances in operation time,single stone clearance rate and AST,ALT,TBil and AMS levels at 7 days after surgery between the two groups(P>0.05).Conclusion For patients with mild acute biliary pancreatitis complicated with gallbladder and extrahepatic biliary calculi,OC+OCBDE and LC+LCBDE can effectively remove diseased gallbladder,remove extrahepatic biliary calculi,improve liver function and control pancreatic inflammation.However,compared with OC+OCBDE,LC+LCBDE has the advantages of less blood loss,rapid recovery of gastrointestinal function,fewer complications,less pain and rapid recovery,and can promote rapid recovery,which is worthy of clinical promotion of minimally invasive surgery.