LC与ERCP联合用于胆囊结石合并肝外胆管结石患者的临床价值

Clinical value of LC combined with ERCP in patients with cholecystolithiasis and extrahepatic bile duct stones

目的探讨腹腔镜胆囊切除手术(LC)联合经内镜逆行胰胆管造影术(ERCP)治疗胆囊结石合并肝外胆管结石的疗效及临床应用价值。方法选取2019年5月至2022年2月延安市安塞区人民医院收治的80例胆囊结石合并肝外胆管结石患者作为研究对象,随机分为观察组和对照组,每组各40例。对照组采用传统开腹手术治疗,观察组采用LC联合ERCP治疗。比较两组手术成功率及1年复发率、手术指标、手术前后炎症因子水平、血管紧张素水平及并发症发生率。结果两组手术成功率比较,差异无统计学意义(P>0.05);观察组1年复发率低于对照组,差异有统计学意义(P<0.05);观察组手术时间、出血量、切口长度、术后排气时间及住院时间均少于对照组,差异均有统计学意义(P<0.05);两组手术后炎症因子及血管紧张素水平均高于手术前,但观察组均低于对照组,差异均有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论LC联合ERCP治疗胆囊结石合并肝外胆管结石疗效明显,可明显缩短手术时间,降低出血量,有利于术后恢复,明显减轻炎症反应,抑制血管紧张素活性,安全性更高,值得临床推广应用。

Objective To investigate the efficacy and clinical application value of laparoscopic cholecystectomy(LC)combined with endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones.Methods A total of 80 patients with gallbladder stones and extrahepatic bile duct stones admitted to the Ansai District People′s Hospital of Yan′an from May 2019 to February 2022 were selected as the research objects.They were randomly divided into observation group and control group,with 40 cases in each group.The control group was treated with traditional laparotomy,and observation group was treated with LC combined with ERCP.The surgical success rate,1-year recurrence rate,surgical indicators,levels of inflammatory factors and angiotensin before and after surgery,and the incidence of complications were compared between the 2 groups.Results There was no significant difference in the success rate of operation between the 2 groups(P>0.05).The 1-year recurrence rate of observation group was lower than that of control group,and the difference was statistically significant(P<0.05).The operation time,bleeding volume,incision length,postoperative exhaust time and hospitalization time of observation group were less than those of control group,and the differences were statistically significant(P<0.05).The levels of inflammatory factors and angiotensin in the 2 groups after operation were higher than those before operation,but those in observation group were lower than those in control group,and the differences were statistically significant(P<0.05).The incidence of complications in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion LC combined with ERCP in the treatment of cholecystolithiasis combined with extrahepatic bile duct stones has obvious curative effect,can significantly shorten the operation time,reduce the amount of bleeding,conducive to postoperative recovery,significantly reduce the inflammatory response,inhibit the activity of angiotensin,higher safety,worthy of clinical application.