ERCP与LBEPS分别联合LC治疗胆囊合并胆总管结石临床疗效比较

Comparison of clinical efficacy of ERCP and LBEPS combined with LC in the treatment of gallbladder complicated with common bile duct stones

目的 对比胆囊(GS)合并胆总管结石(CBDS)患者腹腔镜胆囊切除术(LC)分别联合经内镜逆行胰胆管造影术(ERCP)以及腹腔镜胆总管探查Ⅰ期缝合(LBEPS)效果。方法 选取淮安市第二人民医院2017年5月至2022年2月就诊的GS合并CBDS患者82例的临床资料。采用LBEPS联合LC治疗43例(研究组)、采用ECRP联合LC治疗39例(对照组),对比2组肝功能指标、胰腺损伤指标、手术相关指标、生活质量。结果 研究组术后住院时间(11.28±3.45)d、手术时间(86.72±16.54)min,明显短于对照组的(14.64±4.27)d、(112.42±20.57)min。研究组术中出血量(41.83±7.59)mL,明显低于对照组(46.89±9.61)mL,差异均有统计学意义(P<0.05);2组并发症对比差异无统计学意义(P>0.05)。术后1 d,研究组碱性磷酸酶(ALP)(91.59±8.35)U/L、淀粉酶(AMY)(102.41±11.59)U/L、丙氨酸氨基转移酶(ALT)(61.28±5.24)U/L均高于术前(75.41±6.92)U/L、(81.53±7.96)U/L、(35.87±3.21)U/L(P<0.05);术后1 d,对照组ALT(60.75±5.63)U/L、ALP(90.62±8.11)U/L、AMY(110.84±12.43)U/L均高于术前(35.49±3.46)U/L、(76.83±6.57)U/L、(82.75±7.42)U/L(P<0.05),但术后1 d 2组ALP、ALT比较差异无统计学意义(P>0.05);研究组术后1 d的血清AMY水平(102.41±11.59)U/L,明显低于对照组(110.84±12.43)U/L(P<0.05);术后3个月,2组健康调查简表(SF-36)评分均升高(P<0.05),但2组术后3个月的SF-36评分比较差异无统计学意义(P>0.05)。结论 GS合并CBDS患者LC分别联合ECRP、LBEPS均疗效确切,安全可靠,但LBEPS联合LC更有助于减轻胰腺损伤,可缩短术后住院时间与手术时间,且可减轻手术创伤。

Objective To compare the performances of laparoscopic cholecystectomy(LC) combined with endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic common bile duct exploration(LBEPS) on the patients suffering from gallbladder(GS) and common bile duct stones(CBDS). Methods The clinical data of 82 patients treated for GS and CBDS in our hospital from May 2017 to February 2022 were enrolled and divided into two groups: the LBEPS+LC group(43 cases) and the ERCP+LC group(39 cases) according to different surgical plans. Between the two groups, quality of life, liver function indexes, pancreatic injury indexes, surgery-related indexes were compared. Results LCBDE+LC group had a shorter mean(SD) postoperative length of stay(11.28±3.45 d vs 14.64±4.27 d, P<0.05) and operation time(86.72±16.54 min vs 112.42±20.57 min, P<0.05). In the LCBDE+LC group the intraoperative blood loss was significantly lower than that in the ERCP+LC group(41.83±7.59ml vs 46.89±9.61ml, P<0.05). There was no significant difference in complications between the two groups(P>0.05). On postoperative day 1(POD1), the LCBDE+LC group showed remarkable increases in serum levels of amylase(AMY)(102.41±11.59 U/L vs 81.53±7.96 U/L), alanine aminotransferase(ALT)(61.28±5.24 U/L vs 35.87±3.21 U/L) and alkaline phosphatase(ALP)(91.59±8.35 U/L vs 75.41±6.92 U/L) than pre-operatively(P<0.05). In the ERCP+LC group, ALT(60.75±5.63 U/L vs 35.49±3.46 U/L), ALP(90.62±8.11 U/L vs 76.83±6.57 U/L), and AMY(110.84±12.43 U/L vs 82.75±7.42 U/L) were also higher than pre-operatively(P<0.05). There was no significant difference in ALP and ALT between the two groups on POD1(P>0.05). While serum level of AMY in the LCBDE+LC group was significantly lower than in the ERCP+LC group on POD1(102.41±11.59 U/L vs 110.84±12.43 U/L, P<0.05). At 3 months after operation, the Short-Form Health Survey(SF-36) scores increased in both groups(P<0.05), while no difference was found in the SF-36 scores between the two groups(P>0.05). Conclusion Both protocols have therapeutic effect, but LBEPS combined with LC is more efficacious in ameliorating pancreatic damage, shortening postoperative length of stay and operation time, and reducing surgical trauma.