腹腔镜联合胆道镜术与腹腔镜联合逆行胰胆管造影术治疗胆结石的临床效果研究

Clinical Effect of Laparoscopy Combined with Choledochoscopy and Endoscopic Retrograde Cholangiopancreatog⁃raphy in Treatment of Cholelithiasis

目的:比较腹腔镜联合胆道镜术与腹腔镜联合逆行胰胆管造影术(ERCP)治疗胆结石的临床效果。方法:选取2021年6月—2022年6月在岷县中医院行胆结石手术治疗的90例患者作为研究对象,根据随机数字表法分为胆道镜术联合组与ERCP联合组,各45例。胆道镜术联合组给予腹腔镜联合胆道镜术治疗,ERCP联合组采用腹腔镜联合ERCP治疗。比较两组手术及术后恢复指标、并发症发生情况、血清淀粉酶(AMS)及脂肪酶(LPS)水平。结果:两组术中出血量、手术时间比较,差异无统计学意义(P>0.05);ERCP联合组术后肠道功能恢复时间、住院时间均短于胆道镜术联合组,差异有统计学意义(P<0.001)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。术前,两组AMS、LPS水平比较,差异无统计学意义(P>0.05);术后3、24h,ERCP联合组AMS、LPS水平均高于胆道镜术联合组,差异有统计学意义(P<0.001)。结论:腹腔镜联合胆道镜患者术后急性胰腺炎发生率更低,而腹腔镜联合ERCP手术患者术后恢复时间更短,二者各有优势,需要根据患者自身情况选择术式。

Objective:To compare the clinical effect of laparoscopy combined with choledochoscopy and endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of cholelithiasis.Methods:A total of 90 patients who received cholelithiasis surgery in Minxian Traditional Chinese Medicine Hospital from June 2021 to June 2022 were selected as the study subjects.According to the random number table method,they were divided into choledochoscopy combination group and ERCP combination group,with 45 cases in each group.The choledochoscopy combination group was treated with laparoscopy combined with choledochoscopy,and the ERCP combination group was treated with laparoscopy combined with ERCP.The surgery and postoperative recovery indexes,complications,serum amylase(AMS)and lipase(LPS)levels were compared between the two groups.Results:There was no significant difference in intraoperative blood loss and operation time between the two groups(P>0.05).The postoperative intestinal function recovery time and hospital stay in the ERCP combination group were shorter than those in the choledochoscopy combination group,and the difference was statistically significant(P<0.001).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Before surgery,there was no significant difference in the levels of AMS and LPS between the two groups(P>0.05).At 3 h and 24 h after surgery,the levels of AMS and LPS in the ERCP combination group were higher than those in the choledochoscopy combination group,and the differences were statistically significant(P<0.001).Conclusion:Patients with laparoscopy combined with choledochoscopy have a lower incidence of postoperative acute pancreatitis,while patients with laparoscopy combined with ERCP surgery have a shorter recovery time.These two methods have their own advantages,and it is necessary to choose the surgical approach according to the patient's own situation.