LCBDE与ERCP术治疗胆总管结石患者效果研究

Comparison of laparoscopic common bile duct exploration and ERCP in the treatment of patients with common bile duct stones

目的 比较采取腹腔镜下胆道探查术(LCBDE)与内镜下逆行胰胆管造影术(ERCP)治疗胆总管结石患者的疗效。方法 2018年3月~2022年5月我院收治的胆总管结石患者108例,其中观察组54例采取LCBDE术治疗,另54例对照组采用ERCP术治疗。术后随访1年。采用ELISA法检测血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)和C反应蛋白(CRP)水平。结果 观察组结石清除率为100.0%,与对照组的98.2%比,无显著性差异(P>0.05);观察组手术时间和术后住院日分别为(105.3±12.7)min和(6.3±1.2)d,显著长于对照组【分别为(63.9±7.8)min和(3.8±0.9)d,P<0.05】,观察组术中出血量为(32.2±5.9)mL,显著多于对照组【(10.6±2.5)mL,P<0.05】;在术后1周,两组血清总胆红素、白蛋白和γ-谷氨酰转肽酶水平比较无显著性差异(P>0.05);观察组血清TNF-α、IL-6和CRP水平分别为(59.5±12.8)pg/mL、(7.1±2.2)pg/mL和(14.6±3.3)mg/L,与对照组【分别为(56.8±11.7)pg/mL、(5.9±3.5)pg/mL和(14.7±4.6)mg/L】比,差异无统计学意义(P>0.05);两组术后感染、胆漏和出血等并发症发生率比较无显著性差异(16.7%对13.0%,P>0.05);随访12个月,观察组结石复发率为3.7%,显著低于对照组的14.8%(P<0.05)。结论 采用LCBDE或ERCP术治疗胆总管结石患者疗效接近,两种手术均有较高的结石清除率且安全可行,但LCBDE术后结石复发率更低。

Objective The aim of this study was to compare the efficacy of laparoscopic common bile duct exploration(LCBDE)and endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of patients with common bile duct stones.Methods 108 patients with common bile duct stones were enrolled in our hospital between March 2018 and May 2022,and 54 patients in the observation group underwent LCBDE surgery,while another 54 patients in the control group underwent ERCP surgery.All patients were followed-up for 12 months after operation.Serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)levels were assayed by ELISA.Results The total stone clearance rate in the observation was 100.0%,not significantly different compared to 98.2%in the control(P>0.05);the surgical time and hospital stay in the observation group were(105.3±12.7)min and(6.3±1.2)d,much longer than[(63.9±7.8)min and(3.8±0.9)d,respectively,P<0.05]in the control,and the intraoperational blood loss was(32.2±5.9)mL,much greater than[(10.6±2.5)mL,P<0.05]in the control;one week after operation,there were no significant differences respect to liver function tests in the two groups(P>0.05),and serum TNF-α,IL-6 and CRP levels in the two groups were also not significantly different[(59.5±12.8)pg/mL,(7.1±2.2)pg/mL and(14.6±3.3)mg/L vs.(56.8±11.7)pg/mL,(5.9±3.5)pg/mL and(14.7±4.6)mg/L,respectively,P>0.05];there was no significant difference in the incidence of postoperative complications,such as infection,bile leakage and bleeding,between the two groups(16.7%vs.13.0%,P>0.05);at the end of 12-month follow-up,the stone recurrence rates in the observation group was 3.7%,significantly lower than 14.8%in the control group(P<0.05).Conclusion The efficacy of LCBDE and ERCP in treating patients with common bile duct stones is similar,but the LCBDE has a relatively lower stone recurrence.