Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis

BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.

Clinical efficacy of laparoscopic cholecystectomy combined with endoscopic papillary balloon dilation in treatment of gallbladder stones with common bile duct stones: A retrospective study

BACKGROUND The incidence of cholelithiasis has been on the rise in recent years,but the choice of procedure is controversial.AIM To investigate the efficacy of laparoscopic cholecystectomy(LC)combined with endoscopic papillary balloon dilation(EPBD)in patients with gallbladder stones(GS)with common bile duct stones(CBDS).METHODS The clinical data of 102 patients with GS combined with CBDS were selected for retrospective analysis and divided into either an LC+EPBD group(n=50)or an LC+endoscopic sphincterotomy(EST)group(n=52)according to surgical methods.Surgery-related indexes,postoperative recovery,postoperative complications,and expression levels of inflammatory response indexes were compared between the two groups.RESULTS Total surgical time,stone free rate,rate of conversion to laparotomy,and successful stone extraction rate did not differ significantly between the LC+EPBD group and LC+EST group.Intraoperative hemorrhage,time to ambulation,and length of hospitalization in the LC+EPBD group were lower than those of the LC+EST group(P<0.05).The rate of total complications of the two groups was 9.80%and 17.65%,respectively,and the difference was not statistically significant.No serious complications occurred in either group.At 48 h postoperatively,the expression levels of interleukin-6,tumor necrosis factor-α,high-sensitivity Creactive protein,and procalcitonin were lower in the LC+EPBD group than in the LC+EST group(P<0.05).At 3 d postoperatively,the expression levels of aspartate transaminase,alanine transaminase,and total bilirubin were lower in the LC+EPBD group than in the LC+EST group(P<0.05).CONCLUSION LC combined with EPBD and LC combined with EST are both effective procedures for the treatment of GS with CBDS,in which LC combined with EPBD is beneficial to shorten the patient’s hospitalization time,reduce the magnitude of elevated inflammatory response indexes,and promote postoperative recovery.

Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy

INTRODUCTION The advent of laparoscopic cholecystectomy(LC)inthe late 1980s gained widespread acceptance withina short period of time and has become the preferredtreatment for symptomatic gallstones,but themanagement of coexisting gallbladder and commonbile duct(CBD)stones has remained controversialbecause the various strategies proposed have theirlimitations.In fact,choledocholithiasis

Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis

AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis. METHODS: A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.RESULTS: There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001). CONCLUSION: For treatment of cholecystocholedo-cholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.

The role of endoscopic retrograde cholangiopancreatography in perioperative period of laparoscopic cholecystectomy

Objective: To explore the indications and the value ofendoscopic retrograde cholangiopancreatography(ERCP)in perioperative phase of laparoscopic cholecystecto-my.Methods: From January 1998 to April 1999, a total of1500 consecutive laparoscopic cholecystectomies wereanalyzed. The indications for preoperative group (n=33) included elevated bilirubin level and alkalinephosphatase level, jaundice, pancreatitis, abnormalliver function, dilated bile duct and/or stones on ul-trasound or CT. The indications for postoperativegroup (n=20) included clinical signs or symptoms aswell as common bile duct stones demonstrated by in-traoperative cholangiography.Results: Preoperative ERCP for 32 patients (2.1%)showed abnormalities in 12 (37%). Postoperative ER-CP for 20 patients(1.3%) demonstrated abnormalitiesin 14 (70%). Super-selected criteria for preoperativeERCP would predict more than 66% ductal stones.Endoscopic sphincterectomy and duct stones clearancewere performed in all 16 patients with documentedcommon bile duct stones. The morbidity was confinedin 2 patients with self-limited pancreatitis (3%).Conclusions: Using super-selected creteria to selectpatients for preoperative ERCP can avoid unnecessaryERCP. As soon as postoperative patients have clinicalsigns or symptoms, endoscopic treatment should beperformed.

Role of ERCP in the era of laparoscopic cholecystectomy for the evaluation of choledocholithiasis in sickle cell anemia

AIM:To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC). METHODS:Two hundred and twenty four patients (144 male,80 female; mean age,22.4 years; range,5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ). The indications for ERCP were:CJ only in 97,CJ and dilated bile ducts on ultrasound in 103,and CJ and common bile duct (CBD) stones on ultrasound in 42. RESULTS:In total,CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16. Fifteen were post-LC patients. These had endoscopic sphincterotomy and stone extraction. The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION:In patients with SCA and cholelithiasis,ERCP is valuable whether preoperative or postoperative,and in none was there a need to perform intraoperative cholangiography. Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients. Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

Management of cholelithiasis with choledocholithiasis:Endoscopic and surgical approaches

Gallstone disease and complications from gallstones are a common clinical problem.The clinical presentation ranges between being asymptomatic and recurrent attacks of biliary pain requiring elective or emergency treatment.Bile duct stones are a frequent condition associated with cholelithiasis.Amidst the total cholecystectomies performed every year for cholelithiasis,the presence of bile duct stones is 5%-15%;another small percentage of these will develop common bile duct stones after intervention.To avoid serious complications that can occur in choledocholithiasis,these stones should be removed.Unfortunately,there is no consensus on the ideal management strategy to perform such.For a long time,a direct open surgical approach to the bile duct was the only unique approach.With the advent of advanced endoscopic,radiologic,and minimally invasive surgical techniques,however,therapeutic choices have increased in number,and the management of this pathological situation has become multidisciplinary.To date,there is agreement on preoperative management and the need to treat cholelithiasis with choledocholithiasis,but a debate still exists on how to cure the two diseases at the same time.In the era of laparoscopy and miniinvasiveness,we can say that therapeutic approaches can be performed in two sessions or in one session.Comparison of these two approaches showed equivalent success rates,postoperative morbidity,stone clearance,mortality,conversion to other procedures,total surgery time,and failure rate,but the onesession treatment is characterized by a shorter hospital stay,and more cost benefits.The aim of this review article is to provide the reader with a general summary of gallbladder stone disease in association with the presence of common bile duct stones by discussing their epidemiology,clinical and diagnostic aspects,and possible treatments and their advantages and limitations.

Laparo-endoscopic “Rendezvous” to treat cholecysto-choledocolithiasis: Effective,safe and simplifies the endoscopist’s work

AIM: To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored" RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire. RESULTS: The feasibility was 97.5% and the effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone’s recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases.CONCLUSION: Simultaneous RV carries higheffectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.

Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver function

AIM:To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy,with an acceptable negative rate of endoscopic retrograde cholangiopancreatography.METHODS:All patients with symptomatic gallstones were included in the study.Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography.Patients with normal ultrasoundwere referred to magnetic resonance cholangiopancreatography.All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography.RESULTS:Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations.Twenty-one point five percent had abnormal liver function tests,of which 52.8%had normal ultrasound results.This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2%of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%.It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2%of patients with abnormal liver function.CONCLUSION:This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography,in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.

Choledocholithiasis caused by anatomical variation of cystic duct: A case report

Laparoscopic cholecystectomy(LC)has gradually become the first choice for the treatment of cholecystolithiasis in recent years.Iatrogenic bile duct injury(IBDI)is an important clinical problem in LC.The anatomical variation of the cystic duct increases the probability of IBDI and the difficulty of operation.We present a case of a 44-year-old male with a anatomical variation of the cystic duct complicated with cholecystolithiasis and choledocholithiasis,who successfully underwent choledocholithotomy,choledochoscopic exploration and T-tube drainage surgery.The patient recovered well and was discharged home on postoperative day 10.The T-tube was removed at 1 month postoperatively after cholangiography examination of no choledocholithiasis left.

LC序贯ERCP与LCBDE+LC胆总管一期缝合治疗胆囊结石合并胆总管结石患者的疗效分析

目的比较胆囊结石合并胆总管结石患者采用腹腔镜下胆囊切除(laparoscopic cholecystectomy,LC)序贯内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)与腹腔镜下胆囊切除合经胆总管胆道探查术(laparoscopic cholecystectomy combine with common bile duct exploration,LCBDE)+LC胆总管一期缝合治疗的临床效果。方法回顾性选取2019年1月—2020年12月扬州大学附属苏北人民医院肝胆胰外科中心收治的208例胆囊结石合并胆总管结石患者的临床资料,根据手术方式不同,分为LC序贯ERCP组和LCBDE+LC组,对比两组的围手术期指标(术中出血量、手术时间、术后拔管时间、术后进食时间)、术后近期并发症(胆漏、胰腺炎、高淀粉酶血症、胆管炎、消化道出血)和远期并发症(胆总管结石复发、胆总管狭窄)及术后6个月胆总管结石残留情况、肝功能指标。结果两组术中出血量、术后进食时间比较,差异无统计学意义(P均>0.05);LC序贯ERCP组手术时间长于LCBDE+LC组,住院费用高于LCBDE+LC组,术后拔管时间和住院时间短于LCBDE+LC组,差异有统计学意义(P均<0.05)。LC序贯ERCP组术后胆管炎发生率高于LCBDE+LC组,差异有统计学意义(P<0.05)。术后,LCBDE+LC组血清总胆红素>23.5μmol/L、丙氨酸氨基转移酶>50 U/L、白细胞计数>9.5×109/L的患者占比低于LC序贯ERCP组,差异有统计学意义(P均<0.05)。LC序贯ERCP组术后高淀粉酶血症及胰腺炎发生率为18.00%(18/100),高于LCBDE+LC组的0,术后胆漏发生率为0,低于LCBDE+LC组的11.11%(12/108),差异有统计学意义(χ^(2)=21.282、11.791,P均<0.05)。结论LC序贯ERCP组住院时间及术后恢复时间相对较短,LCBDE+LC胆总管一期缝合总体并发症的发生更少,术后肝功能恢复快,总体花费低,两组患者疗效和安全性均可靠。

腹腔镜下胆囊切除术联合腹腔镜下胆总管探查术治疗胆囊结石合并胆总管结石患者疗效研究

目的探讨腹腔镜下胆囊切除术(LC)联合腹腔镜下胆总管探查术(LCBD)治疗胆囊结石合并胆总管结石患者的疗效。方法2018年3月~2022年5月我院诊治的胆囊结石合并胆总管结石患者85例,均接受LC联合LCBDE手术治疗,其中42例观察组采用经鼻胆管引流,另43例对照组采用T管引流。应用胃肠道生活质量指数(GIQLI)问卷评估生活质量。结果观察组引流管拔除时间和医疗花费分别为(5.6±1.8)d和(3.5±0.5)万元,均显著短于或少于对照组[分别为(50.5±6.8)d和(3.9±0.7)万元,P<0.05];在术后1 w,观察组血清ALT和AST水平分别为(37.1±14.6)U/L和(36.7±16.8)U/L,均显著低于对照组【分别为(79.7±13.8)U/L和(53.5±14.7)U/L,P<0.05】;在术后1个月,观察组GIQLI评分为(98.5±3.3)分,显著高于对照组【(81.4±3.9)分,P<0.05】;术后观察组肝功能异常发生率为40.5%,显著低于对照组的65.1%(P<0.05),而两组胆漏、胰腺炎、胆总管结石残留和出血发生率比较,无显著性差异(P>0.05)。结论在采用LC联合LCBDE术治疗胆囊结石合并胆总管结石患者时放置鼻胆管引流可能是一种技术进步,可免除T管引流对患者术后生活质量的干扰,对维持正常的消化功能也有积极的意义。

胆总管结石合并胆囊结石患者内镜逆行胰胆管造影术后行腹腔镜胆囊切除术的时机研究

目的探讨胆总管结石合并胆囊结石患者内镜逆行胰胆管造影术(ERCP)后行腹腔镜胆囊切除术(LC)的时机。方法回顾性分析该院2015年6月-2023年5月258例接受ERCP联合LC治疗胆总管结石合并胆囊结石的患者的临床资料。按照ERCP与LC间期不同分为:A组(≤24 h)、B组(24~72 h)和C组(>72 h)。结果C组LC手术时间为58.0(46.0,73.0)min,明显长于A组的43.5(35.3,51.0)min和B组的43.0(35.0,51.0)min;C组腹腔引流管留置率为31.3%(21/67),明显高于A组的8.9%和B组的8.1%;B组行四孔法LC的3例(2.2%),明显少于A组的7例(12.5%)和C组的9例(13.4%),C组住院总时间长于A组和B组,差异均有统计学意义(P<0.05)。3组患者术后并发症总发生率、再次ERCP率、LC术后住院时间和住院费用比较,差异均无统计学意义(P>0.05)。结论ERCP术后24~72 h行LC是胆总管结石合并胆囊结石患者安全、有效、易行和经济的治疗时机。

LCBDE+LC一步法对胆囊结石合并胆总管结石患者术后恢复及血清炎症因子水平的影响

目的:探究腹腔镜胆总管探查术(LCBDE)+腹腔镜胆囊切除术(LC)一步法治疗胆囊结石合并胆总管结石(CCWC)的临床效果。方法:选取温州医科大学附属衢州医院2021年1月—2024年1月收治的80例CCWC患者,按随机数字表法分为两组,各40例。对照组行内镜逆行胰胆管造影(ERCP)+LC序贯二步法治疗,观察组行LCBDE+LC一步法治疗。比较两组手术情况、术后恢复情况、血清炎症因子水平、应激反应、肝胆功能、并发症发生情况。结果:观察组总手术时间、住院时间、术后排气时间及肠鸣音恢复时间均短于对照组,差异均有统计学意义(P<0.05);观察组术后血清炎症因子水平、应激反应指标水平及肝胆功能指标水平均较对照组低,并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论:LCBDE+LC一步法治疗CCWC效果更佳,利于减轻手术应激反应,减少炎症因子释放,且手术效率更高,术后恢复时间短,并发症少。

LC联合ESBD治疗胆囊结石合并胆总管结石的效果

目的:探讨腹腔镜胆囊切除术(LC)联合十二指肠乳头括约肌小切开加球囊扩张术(ESBD)治疗胆囊结石合并胆总管结石的效果。方法:回顾性选取2022年5月—2023年6月淮安市第五人民医院收治的95例胆囊结石合并胆总管结石患者。根据不同手术方式将其分为对照组(47例)和观察组(48例)。对照组行LC联合腹腔镜经胆囊管胆道探查术(LTCBDE),观察组行LC联合ESBD治疗。比较两组围手术期指标,术前、术后血清生化指标、炎症因子及并发症。结果:观察组手术时间短于对照组,术后首次排气时间早于对照组,差异有统计学意义(P<0.05)。术后3 d,两组直接胆红素(DBIL)、碱性磷酸酶(ALP)和γ-谷氨酰转移酶(GGT)水平均低于术前,观察组DBIL、ALP和GGT水平均低于对照组,差异有统计学意义(P<0.05)。术后3 d,两组高迁移率族蛋白B1(HMGB1)和降钙素原(PCT)均高于术前,糖蛋白抗原19-9(CA19-9)低于术前,观察组HMGB1和PCT、CA19-9均低于对照组,差异有统计学意义(P<0.05)。两组并发症比较,差异无统计学意义(P>0.05)。结论:LC联合LTCBDE和LC联合ESBD均可有效清除结石,但LC联合ESBD可进一步缩短手术时间,促进术后肝功能的恢复,并可减轻术后炎症反应。

经不同部位胆管切开取石联合LC治疗胆总管结石合并胆囊结石的效果观察

目的观察经不同部位切开取石联合腹腔镜胆囊切除术(LC)治疗胆总管结石合并胆囊结石的临床效果,探讨胆道切开部位选择标准的实用性。方法回顾性纳入2021年6月至2024年1月首都医科大学附属北京积水潭医院收治的127例胆总管结石合并胆囊结石患者,术前根据磁共振胆胰管成像(MRCP)影像评估胆总管结石大小和数量,决定术中胆道切开部位实施探查和取石治疗:(1)若结石数量≤3枚且结石长径≤1 cm,切开胆囊管并扩张后应用胆道镜探查取石;胆囊管口径小无法置入胆道镜、无法取出结石、胆道镜无法探查肝总管且无法确认肝总管有无残余结石时,切开部分胆管侧壁扩大开口进行手术,变更为胆囊管联合胆总管微切开探查取石;(2)若存在结石数量>3枚、结石长径>1 cm、重症胆管炎、胆囊管经后方汇入等因素时,切开胆总管前壁取石。结果127例中胆总管结石数量为1枚者65例,2~3枚者14例,多于3枚者48例;结石长径0.5~2.5 cm。69例采取经胆囊管探查术,成功探查并取石48例(经胆囊管取石组),其余21例加做胆总管微切开进行探查和取石(胆囊管联合胆总管微切开组),两组患者的术后住院时间[(3.6±1.0)dvs(4.2±2.9)d]差异没有统计学意义(P>0.05)。58例采取经胆总管前壁切开取石,其中35例留置T管,23例一期缝合关闭胆管切口。留置T管患者较一期缝合患者的术前肝功能指标(GGT)水平更高,术后住院时间更长、住院费用更高,差异均有统计学意义(均P<0.05)。结论经胆囊管切开取石、胆囊管联合胆总管微切开取石以及经胆总管前壁切开取石都是腹腔镜术中处理胆总管结石的安全有效术式,术前精准评估胆管结石数量和大小有助于个体化的术式选择,在保证疗效的同时加速患者康复。

内镜下逆行胰胆管造影术后不同时间行腹腔镜下胆囊切除术对老年胆囊结石伴胆总管结石患者疼痛应激反应的影响

目的探讨内镜下逆行胰胆管造影术后不同时间行腹腔镜下胆囊切除术治疗老年胆囊结石伴胆总管结石的效果。方法选取2019年8月至2022年8月收治的120例老年胆囊结石伴胆总管结石患者为研究对象,根据内镜下逆行胰胆管造影术后行腹腔镜下胆囊切除术的时间不同将其分为A组、B组,各60例。A组在内镜下逆行胰胆管造影术后3 d内行腹腔镜下胆囊切除术,B组在术后3 d后行腹腔镜下胆囊切除术。比较两组的手术效果。结果术后,A组的白细胞介素-6(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)水平低于B组(P<0.05)。术后,A组的缓激肽(BK)、P物质(SP)及前列腺素E2(PGE2)水平均低于B组(P<0.05)。A组的术后并发症总发生率低于B组(P<0.05)。结论内镜下逆行胰胆管造影术后3 d内行腹腔镜下胆囊切除术可减轻老年胆囊结石伴胆总管结石患者的炎症反应和疼痛应激反应,降低术后并发症发生率,值得推广。

ERCP取石后不同时机行腹腔镜胆囊切除术对胆囊胆总管结石患者术后恢复的影响

目的对比研究经内镜逆行胰胆管造影(ERCP)取石后不同时机行腹腔镜胆囊切除术(LC)对胆囊胆总管结石患者术后恢复的影响。方法回顾性选取200例胆囊胆总管结石患者,根据治疗方法分为两组,观察组100例于ERCP术后24~72 h内行LC术,对照组100例于ERCP术后72 h后行LC术,比较两组患者手术一般指标、胃肠功能、治疗疗效、治疗前后血清指标变化、肝功能及并发症发生率。结果观察组手术时间、术后住院时间、肠鸣音恢复时间、肛门排气时间均短于对照组(t分别=5.63、2.31、7.26、5.27,P均<0.05);观察组中转开腹率、结石清除率与对照组比较,差异均无统计学意义(P均>0.05),观察组再次入院率明显低于对照组(χ^(2)=3.66,P<0.05);观察组治疗后白细胞(WBC)、总胆红素(TBIL)与对照组比较,差异均无统计学意义(t分别=0.42、0.57,P均>0.05),但超敏C反应蛋白(hs-CRP)、天门冬氨酚氨基转移酶(ALT)、丙氨酸氨基转移酶(AST)水平明显低于对照组(t分别=4.31、3.03、3.46,P均<0.05);观察组总并发症发生率为5.00%低于对照组18.00%(χ^(2)=5.33,P<0.05)。结论对胆囊胆总管结石患者行ERCP取石后24~72 h内行LC术,能有效缩短患者住院时间,加快胃肠道功能恢复,降低再住院率,降低肝脏损伤,减少并发症发生,利于患者术后恢复。

LC+ERCP/EST治疗胆囊结石合并肝外胆管结石患者疗效研究

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。

两种微创术式治疗胆囊结石合并胆总管结石的效果比较

目的比较分析腹腔镜胆总管探查术(LCBDE)联合腹腔镜胆囊切除术(LC)与经内镜逆行胰胆管造影(ERCP)/内镜下Oddi括约肌切开术(EST)联合LC治疗胆囊结石合并胆总管结石的疗效。方法回顾性分析新疆医科大学第二附属医院2013年6月-2016年6月进行微创手术治疗胆囊结石合并胆总管结石的患者56例,其中24例行LCBDE+LC治疗,32例行ERCP/EST+LC治疗,对两种治疗方法的手术成功率、手术时间、术后肛门排气时间、住院时间、住院费用、术后并发症等临床资料进行比较。计量资料2组间比较采用t检验。结果 LCBDE+LC组手术成功22例(91.67%),中转开腹2例(8.33%),术后并发胆漏2例;ERCP/EST+LC组手术成功30例(93.75%),中转开腹2例(6.25%),术后并发胰腺炎6例、出血1例。2组术后胰腺炎的发生率比较差异有统计学意义(χ~2=5.040,P=0.035)。LCBDE+LC组在手术时间、住院时间、住院费用方面低于ERCP/EST+LC组,且差异有统计学意义(t值分别为-5.818、-5.393、-3.566,P值均<0.05)。结论 LCBDE+LC和ERCP/EST+LC均是治疗胆囊结石合并胆总管结石的有效微创疗法,但要根据患者的不同情况选择合适的治疗方式。