双镜联合治疗胆囊结石合并肝外胆管结石患者疗效及安全性分析

Double endoscopic surgery in the treatment of patients with gallbladder stones and extrahepatic bile duct stones

目的探讨采取双镜联合治疗胆囊结石(GS)合并肝外胆管结石(EBDS)患者的疗效及安全性。方法2020年1月~2022年12月我院收治的GS合并EBDS患者76例,其中观察组42例接受内镜下逆行胰胆管造影术(ERCP)治疗,5 d后进行腹腔镜下胆囊切除术(LC)治疗,对照组34例接受传统开腹手术治疗。采用视觉模拟评分法(VAS)评估疼痛程度,采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)和皮质醇(Cor)。结果两组结石清除率均为100.0%,观察组手术时间、术中出血量和术后3 d VAS评分分别为(96.8±7.4)min、(25.7±5.3)ml和(2.8±0.7)分,显著短于或少于对照组【分别为(120.1±9.6)min、(46.0±6.8)ml和(3.5±0.6)分,P<0.05】;在术后7 d,观察组血清AST和ALT水平分别为(40.5±3.9)U/L和(43.1±4.9)U/L,显著低于对照组【分别为(50.2±5.0)U/L和(56.9±6.0)U/L,P<0.05】;观察组血清TNF-α、IL-6、CRP、Cor和外周血WBC计数分别为(1.5±0.3)ng/L、(10.8±2.0)ng/L、(13.4±2.5)mg/L、(224.7±28.1)mmol/L和(9.8±1.3)×10^(9)/L,均显著低于对照组【分别为(2.7±0.5)ng/L、(16.1±2.5)ng/L、(22.0±4.9)mg/L、(262.4±31.8)mmol/L和(12.0±1.5)×10^(9)/L,P<0.05】;术后,观察组并发症发生率为7.2%,显著低于对照组的23.5%(P<0.05)。结论采用双镜联合治疗GS合并EBDS患者能有效改善围术期指标,促进术后恢复,缓解应激反应,减少并发症。

Objective This study was conducted to investigate double endoscopic surgery in the treatment of patients with gallbladder stones(GS)and extrahepatic bile duct stones(EBDS).Methods 76 patients with GS and EBDS were encountered in our hospital between January 2020 and December 2022,42 patients in the observation group received laparoscopic cholecystectomy(LC)five days after endoscopic retrograde cholangiopancreatography(ERCP)for the removal of common bile duct stones,and 34 patients in the control underwent traditional open surgery.The pain was evaluated by visual analogue scale(VAS),and serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)and cortisol(Cor)levels were detected by ELISA.The white blood cell counts(WBC)were detected by full-automatic blood cell analyzer.Results The stone clearance rates in the two groups were both 100.0%;the operation time,intraoperative blood loss and VAS score at day 3 after surgery in the observation were(96.8±7.4)min,(25.7±5.3)ml and(2.8±0.7),significantly shorter or less than[(120.1±9.6)min,(46.0±6.8)ml and(3.5±0.6),respectively,P<0.05]in the control;seven days after operation,serum AST and ALT levels were(40.5±3.9)U/L and(43.1±4.9)U/L,both significantly lower than[(50.2±5.0)U/L and(56.9±6.0)U/L,P<0.05]in the control;serum TNF-α,IL-6,CRP,Cor levels and WBC counts were(1.5±0.3)ng/L,(10.8±2.0)ng/L,(13.4±2.5)mg/L,(224.7±28.1)mmol/L and(9.8±1.3)×10^(9)/L,all significantly lower than[(2.7±0.5)ng/L,(16.1±2.5)ng/L,(22.0±4.9)mg/L,(262.4±31.8)mmol/L and(12.0±1.5)×10^(9)/L,respectively,P<0.05]in the control;post-operationally,the incidence of complications in the observation group was 7.2%,much lower than 23.5%(P<0.05)in the control.Conclusion The double endoscopic surgery could effectively improve perioperative indexes,promote postoperative recovery,relieve stress response and reduce the complications in patients with GS and EBDS.