LC联合ERCP对胆囊结石伴胆总管结石患者围手术期指标及肝功能的影响

Effect of LC Combined with ERCP on Perioperative Index and Liver Function in Patients with Cholecystolithiasis and Choledocholith

目的:分析腹腔镜胆囊切除术(LC)联合内镜逆行胰胆管造影术(ERCP)在胆囊结石伴胆总管结石患者中的效果。方法:选取2021年5月—2023年5月中国贵航集团三0二医院收治的82例胆囊结石伴胆总管结石患者,按随机数字表法分为两组,各41例。对照组行LC+经腹腔镜胆总管切开取石术(LCBED),观察组行LC+ERCP,术后随访3个月。比较两组围手术期指标、肝功能、炎症因子水平、并发症发生率。结果:观察组术中出血量少于对照组,手术时间长于对照组,下床活动时间、排气时间、住院时间均短于对照组,并发症发生率低于对照组(P<0.05)。术后1 d,观察组白细胞介素-6(IL-6)、C反应蛋白(CRP)、淀粉酶(AMS)、肿瘤坏死因子-α(TNF-α)均低于对照组(P<0.05);术后1 d,两组谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)比较无明显差异(P>0.05)。结论:LC联合ERCP虽然手术时间较长,但其具有更小的创伤、更少的并发症,能够更有效地减轻炎症反应,且对患者肝功能无明显损伤,有利于胆囊结石伴胆总管结石患者快速恢复。

Objective:To analyze the efficacy of laparoscopic cholecystectomy(LC)combined with endoscopic retrograde cholangiopancreatography(ERCP)in patients with cholecystolithiasis combined with choledocholith.Method:A total of 82 patients with cholecystolithiasis combined with choledocholith admitted to China Guihang Group 302 Hospital from May 2021 to May 2023 were selected and divided into two groups according to random number table method,with 41 cases in each group.The control group underwent LC+laparoscopic common bile duct exploration T-tube choledochotomy(LCBED),and the observation group underwent LC+ERCP,and they were followed up for 3 months.Perioperative indexes,liver function,inflammatory factors and incidence of complications were compared between the two groups.Result:The amount of blood loss during surgery in the observation group was less than that in the control group,the surgery time was longer than that in the control group,the time of getting out of bed,the time of exhaust and the time of hospitalization were shorter than those in the control group,and the incidence of complications was lower than that in the control group(P<0.05).At 1 d after surgery,interleukin-6(IL-6),C reactive protein(CRP),amylase(AMS)and tumor necrosis factor-α(TNF-α)in observation group were lower than those in control group(P<0.05).There were no significant differences in aspartate aminotransferase(AST),alanine aminotransferase(ALT)and total bilirubin(TBIL)between the two groups at 1 d after surgery(P>0.05).Conclusion:Although LC combined with ERCP has a long surgery time,it has less trauma and fewer complications,can more effectively reduce inflammation,and has no obvious damage to the liver function,which is conducive to the rapid recovery of patients with cholecystolithiasis and choledocholith,which can be popularized and applied.