LC+ERCP/EST治疗胆囊结石合并肝外胆管结石患者疗效研究

Clinical efficacy of LC combined with ERCP/EST in treating gallbladder stones complicated by extrahepatic bile duct stones

目的探讨胆囊结石并发肝外胆管结石经腹腔镜胆囊切除术(LC)联合内窥镜逆行胰胆管造影术(ERCP)/内窥镜下括约肌切开术(EST)治疗的临床效果。方法选取2020年1月—2023年6间就诊于南平市第一医院的86例胆囊结石合并肝外胆管结石患者,根据治疗方案不同分为对照组(n=40)和观察组(n=46)。对照组给予LC联合经腹腔镜胆总管切开取石术(LCBDE)治疗,观察组给予LC联合ERCP、EST在治疗,观察两组手术相关指标情况、血管紧张素水平、肝功能以及并发症发生情况。结果观察组患者术中出血量少于对照组的(t=12.440,P<0.001),观察组手术用时、肛门排气时间以及住院时间均短于对照组(均P<0.001);观察组血管紧张素1-7(Ang1-7)、血管紧张素Ⅰ(AngⅠ)、血管紧张素Ⅱ(AngⅡ)水平低于对照组,组间比较差异均无统计学意义(均P>0.05);观察组总胆红素(TBIL)、谷氨酸转氨酶(ALT)水平低于对照组水平,组间比较差异无统计学意义(均P>0.05);观察组无患者发生胆漏、结石残留,对照组胆漏、结石残留发生率分别为5.00%、2.50%,组间对比差异均无统计学意义(均P>0.05),观察组出血、胆道感染生率分别为4.35%、2.17%低于对照组10.00%、5.00%,组间对比差异均无统计学意义(均P>0.05)。结论LC联合ERCP/EST治疗胆囊结石合并肝外胆管结石可以减少术中出血,缩短手术用时和住院时间。

Objective This study aims to investigate the clinical efficacy of laparoscopic cholecystectomy(LC)combined with endoscopic retrograde cholangiopancreatography(ERCP)or endoscopic sphincterotomy(EST)in the treatment of gallbladder stones complicated by extrahepatic bile duct stones.Methods A total of 86 patients with gallbladder stones and extrahepatic bile duct stones treated at the First Hospital of Nanping from January 2020 to June 2023 were selected.According to different treatment regimens,they were divided into a control group(n=40)and an observation group(n=46).The control group received LC combined with laparoscopic common bile duct exploration(LCBDE),while the observation group received LC combined with ERCP and EST.Surgical-related indicators,angiotensin levels,liver function,and complications were observed in both groups.Results The observation group had less intraoperative bleeding than the control group(t=12.440,P<0.001).The observation group had a shorter operation time,postoperative anal exhaust time,and hospital stay than the control group(all P<0.001).The levels of angiotensin 1-7(Ang1-7),angiotensin I(AngⅠ),and angiotensin Ⅱ(AngⅡ)in the observation group were lower than those in the control group,with no statistically significant differences between the groups(all P>0.05).Total bilirubin(TBIL)and alanine aminotransferase(ALT)levels in the observation group were comparable to those in the control group(all P>0.05).No patients in the observation group experienced bile leakage or residual stones,while the incidence rates in the control group were 5.00% and 2.50%,respectively,with no statistically significant differences between the groups(all P>0.05).The observation group had lower rates of bleeding and biliary tract infection at 4.35% and 2.17%,respectively,compared to the control group at 10.00% and 5.00%,with no statistically significant differences between the groups(all P>0.05).Conclusions LC combined with ERCP/EST in the treatment of gallbladder stones complicated by extrahepatic bile duct stones can reduce intraoperative bleeding,shorten operation time,and decrease hospital stay.