ERCP联合腹腔镜胆囊切除术治疗胆总管结石的临床研究

Clinical Study of ERCP Combined with Laparoscopic Cholecystectomy in the Treatment of Choledocholithiasis

目的:探讨内镜逆行胰胆管造影术(ERCP)联合腹腔镜胆囊切除术(LC)对胆总管结石患者的治疗效果。方法:选取抚州市第一人民医院2020年8月—2022年2月100例胆总管结石患者,按随机数字表法将其分为对照组50例[LC联合胆总管探查取石术(LCBDE)治疗],观察组50例(ERCP+LC)。比较两组临床指标、残留结石率、复发率、炎症指标及并发症发生率。结果:观察组术中出血量(13.27±5.39)mL少于对照组(43.59±6.48)mL(P<0.05)。观察组手术时间(62.04±13.58)min短于对照组(112.65±15.47)min,引流管留置时间(4.10±1.39)d、住院时间(10.96±1.42)d均短于对照组(7.85±1.76)、(13.68±2.20)d(P<0.05)。两组残留结石率、复发率比较,差异均无统计学意义(P>0.05)。术后48 h,观察组白细胞(WBC)计数(10.25±1.63)×10^(9)/L、降钙素原(PCT)(0.23±0.10)ng/mL均低于对照组(12.69±1.08)×10^(9)/L、(0.31±0.12)ng/mL(P<0.05)。观察组并发症发生率为4.00%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论:胆总管结石患者实施ERCP联合LC治疗,能改善其生理应激状态,缩短手术时间,减少术后并发症,加快术后恢复速度。

Objective:To investigate the therapeutic effect of endoscopic retrograde cholangiopancreatography(ERCP)combined with laparoscopic cholecystectomy(LC)on patients with choledocholithiasis.Method:A total of 100 patients with choledocholithiasis in First People's Hospital of Fuzhou from August 2020 to February 2022 were selected.They were divided into two groups according to the random number table method,50 cases in the control group[LC combined with laparoscopic common bile duct exploration(LCBDE)]and 50 cases in the observation group(ERCP+LC).The clinical indicators,residual stone rate,recurrence rate,inflammatory indicators and the incidence of complications were compared between the two groups.Result:The intraoperative blood loss in the observation group was(13.27±5.39)mL less than(43.59±6.48)mL in the control group(P<0.05).The operation time of the observation group was(62.04±13.58)min,which was shorter than(112.65±15.47)min of the control group,the retention time of drainage tube and hospitalization time were(4.10±1.39)d and(10.96±1.42)d,which were shorter than(7.85±1.76)d and(13.68±2.20)d in the control group(P<0.05).There were no significant differences in residual stone rate and recurrence rate between the two groups(P>0.05).48 h after operation,the WBC count and PCT of observation group were(10.25±1.63)×10^(9)/L and(0.23±0.10)ng/mL respectively,which were lower than(12.69±1.08)×10^(9)/L and(0.31±0.12)ng/mL of the control group(P<0.05).The incidence of complications in the observation group was 4.00%,which was lower than 20.00% in the control group,the difference was statistically significant(P<0.05).Conclusion:ERCP combined with LC can improve the physiological stress state of patients with choledocholithiasis,shorten the operation time,reduce postoperative complications,and accelerate the recovery rate.