腹腔镜胆囊切除术联合ERCP治疗胆总管结石患者的效果及对肝功能的影响

Effect of Laparoscopic Cholecystectomy Combined with ERCP on Choledocholithiasis and Its influence on Liver Function

目的:探讨腹腔镜胆囊切除术(LC)联合经内镜逆行性胰胆管造影术(ERCP)治疗胆总管结石患者的效果及对肝功能的影响。方法:回顾性分析2017年3月-2019年12月厦门大学附属第一医院杏林分院接受治疗的96例胆总管结石患者的临床资料,按手术方法将其分为对照组和观察组,每组48例。对照组给予LC联合胆总管切开取石术,观察组给予LC+ERCP治疗。比较两组围术期相关指标、肝功能[总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(γ-GT)]及并发症发生情况。结果:观察组手术时间长于对照组,术中失血量少于对照组,住院时间短于对照组,术后排气时间早于对照组,差异均有统计学意义(P<0.05)。出院时,观察组TBIL、AST、ALT、γ-GT分别为(22.43±3.20)μmol/L、(48.24±6.10)U/L、(38.21±5.24)U/L、(31.55±4.23)U/L,均低于对照组的(28.56±3.42)μmol/L、(56.38±7.33)U/L、(46.49±5.83)U/L、(38.25±4.07)U/L,差异均有统计学意义(P<0.05)。观察组并发症发生率为12.50%,低于对照组的29.17%,差异有统计学意义(P<0.05)。结论:胆总管结石患者行LC+ERCP治疗,其所需手术时间虽相对较长,但其恢复肝功能效果更佳,术中出血量及术后并发症更少,利于患者术后康复。

Objective:To investigate the effect of laparoscopic cholecystectomy(LC)combined with endoscopic retrograde cholangio pancreatography(ERCP)in the treatment of patients with choledocholithiasis and its influence on liver function.Method:The clinical data of 96 patients with choledocholithiasis treated in Xinglin Branch of the First Affiliated Hospital of Xiamen University from March 2017 to December 2019 were retrospectively analyzed,and they were divided into control group and observation group according to surgical methods,with 48 cases in each group.The control group was given LC combined with choledocholithotomy,and the observation group was given LC+ERCP.Perioperative related indexes,liver function[total bilirubin(TBIL),aspartate aminotransferase(AST),alanine aminotransferase(ALT),γ-glutamyl transpeptidase(γ-GT)]and the incidence of complications were compared between two groups.Result:The operation time of the observation group was longer than that of the control group,the intraoperative blood loss of the observation group was less than that of the control group,the length of hospital stay of the observation group was shorter than that of the control group,and postoperative exhaust time of the observation group was earlier than that in the control group,the differences were statistically significant(P<0.05).At discharge,TBIL,AST,ALT andγ-GT of the observation group were(22.43±3.20)μmol/L,(48.24±6.10)U/L,(38.21±5.24)U/L,(31.55±4.23)U/L,respectively,which were lower than(28.56±3.42)μmol/L,(56.38±7.33)U/L,(46.49±5.83)U/L,(38.25±4.07)U/L of the control group,the differences were statistically significant(P<0.05).The incidence of complications of the observation group was 12.50%,which was lower than 29.17%of the control group,the difference was statistically significant(P<0.05).Result:Although patients with choledocholithiasis receive LC+ERCP treatment,the operation time is relatively long,but the effect of liver function recovery is better,the amount of intraoperative blood loss and postoperative complications are less,which is conducive to the postoperative rehabilitation of patients.