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.

Sinistroposition of the gallbladder and common bile duct

BACKGROUND: Despite its rare incidence, few cases of left-side gallbladder have been already published. METHODS: We reported herein the case of a 29-year-old man with a left liver tumor in whom left lateral bisegmen- tectomy was mandatory. It represents the first description of a sinistroposition of both gallbladder and common bile duct. RESULTS: Surgical exploration revealed a left-side gall- bladder , located under the left lobe of the liver. During he- patic parenchyma dissection at the left side of the round liga- ment and the Rex recessus, the common bile duct was in- jured. Complete separation of hepatic pedicle structures showed that the upper biliary convergence passed on the left side of the Rex recessus before reaching the hepatoduo- denal ligament. CONCLUSION: Only careful dissection of the hepatoduo- denal ligament up to Rex recessus level prior to liver paren- chyma resection could avoid biliary tract injury during left lobectomy.

Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBD calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi to<5 mm size and clear the same during ERCP.Complete clearance of the CBD was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.

Clinical observation of laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography or common bile duct lithotripsy

BACKGROUND The incidence of common bile duct(CBD) stones accounts for approximately 10%–15% of all CBD diseases.Approximately 8%–20% of these patients also have gallstones with heterogenous signs and symptoms.AIM To investigate the clinical effects of laparoscopic cholecystectomy(LC) combined with endoscopic retrograde cholangiopancreatography(ERCP) and LC with CBD excision and stone extraction in one-stage suture(LBEPS) for the treatment of gallbladder and CBD stones.METHODS Ninety-four patients with gallbladder and CBD stones were selected from our hospital from January 2018 to June 2021.They were randomly divided into study and control groups with 47 patients each.The study group underwent LC with ERCP,and the control group underwent LC with LBEPS.Surgery,recovery time of gastrointestinal function,complication rates,liver function indexes,and stress response indexes were measured pre-and postoperatively in both the groups.RESULTS The durations of treatment and hospital stay were shorter in the study group than in the control group.There was no significant difference between the one-time stone removal rate between the study and control groups.The time to anal evacuation,resumption of oral feeding,time to bowel sound recovery,and time to defecation were shorter in the study group than in the control group.The preoperative serum direct bilirubin(DBIL),total bilirubin(TBIL),and alanine aminotransferase(ALT) levels were insignificantly higher in the study group than that in the control group.A day after surgery,the postoperative serum DBIL,TBIL,and ALT levels were lower than their preoperative levels in both groups,and of the two groups,the levels were lower in the study group.Although the preoperative serum adrenocorticotrophic(ACTH),cortisol(COR),epinephrine(A),and norepinephrine(NE) levels were higher in the study group than that in the control group,these differences were not significant(P > 0.05).The serum ACTH,COR,A,and NE levels in both groups decreased one day after surgery compared to the preoperative levels,but the inter-group difference was statistically insignificant.Similarly,(91.79 ±10.44) ng/mL,A,and NE levels were lower in the study group than in the control group.The incidence of complications was lower in the study group than in the control group.CONCLUSION LC combined with ERCP induces only a mild stress response;this procedure can decrease the risk of complications,improve liver function,and achieve and promote a faster recovery of gastrointestinal functions.

Relationship between pancreaticobiliary maljunction and gallbladder carcinoma: a meta-analysis

BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analysis. Data were extracted independently by two reviewers using a predefined spreadsheet. RESULTS: The incidence of PBM was higher in GBC patients than in controls (10.60% vs 1.76%, OR: 7.41, 95% CI: 5.03 to 10.87, P<0.00001). The proportion of female patients with PBM was 1.96-fold higher than in GBC patients without PBM (80.5% vs 62.9%, OR: 1.96, 95% CI: 1.09 to 3.52, P=0.12). GBC patients with PBM were 10 years younger than those without PBM (SMD: -9.90, 95% CI: -11.70 to -8.10, P<0.00001). And a difference in the incidence of associated gallstone was found between GBC patients with and without PBM (10.8% vs 54.3% OR: 0.09, 95% CI: 0.05 to 0.17, P<0.00001). Among the GBC patients with PBM, associated congenital dilatation of the common bile duct was present with a higher incidence ranging from 52.2% to 85.7%, and 70.0%-85.7% of them belonged to the P-C type of PBM (the main pancreatic duct enters the common bile duct). No substantial heterogeneity was found and no evidence of publication bias was observed.CONCLUSIONS: PBM is a high-risk factor for developing GBC, especially the P-C type of PBM without congenital dilatation of the common bile duct. To prevent GBC, laparoscopic cholecystectomy is highly recommended for PBM patients without congenital dilatation of the common bile duct, especially relatively young female patients without gallstones.

Cystic duct dilation through endoscopic retrograde cholangiopancreatography for treatment of gallstones and choledocholithiasis: Six case reports and review of literature

BACKGROUND Choledocholithiasis removal via endoscopic retrograde cholangiopancreatography(ERCP)then followed by laparoscopic cholecystectomy(LC)has gradually become the principal method in the treatment of gallstones and choledocholithiasis.We use ERCP through the cystic duct to treat gallstones combined with choledocholithiasis,with the aim to preserve the normal function of the gallbladder while simultaneously decreasing risk of biliary tract injury.CASE SUMMARY A total of six cases of patients diagnosed with gallstones and choledocholithiasis were treated with ERCP.The efficacy was evaluated via operation success rate,calculus removal rate,postoperative hospital stay and average hospitalization costs;the safety was evaluated through perioperative complication probability,gallbladder function detection and gallstones recrudesce.The calculus removal rate reached 100%,and patients had mild adverse events,including 1 case of postoperative acute cholecystitis and another of increased blood urinary amylase;both were relieved after corresponding treatment,the remaining cases had no complications.The average hospital stay and hospitalization costs were 6.16±1.47 d and 5194±696 dollars.The 3-11 mo follow-up revealed that gallbladder contracted well,without recurrence of gallstones.CONCLUSION This is the first batch of case reports for the treatment of gallstones and choledocholithiasis through ERCP approached by natural cavity.The results and effects of six reported cases proved that the new strategy is safe and feasible and is worthy of further exploration and application.

Rat model of cholelithiasis with human gallstones implanted in cholestasis-induced virtual gallbladder

AIM:To facilitate translational research on cholelithiasis,we have developed a rat model of human gallstones by exploiting the unique biliopancreatic features of this species.METHODS:Under anesthesia,16 adult rats of equal genders underwent two times of abdominal surgery.First,their common bile duct(CBD)was ligated to cause cholestasis by total biliary obstruction(TBO).On day 0,1,3,7,14,21 and 28 after TBO,magnetic resonance imaging(MRI)was conducted to monitor the dilatation of the CBD,and blood was sampled to analyze total serum bilirubin(TSB).Secondly,on day 30,the abdomen was re-opened and gallstone(s)collected from human patients were implanted in the dilated CBD asa virtual gallbladder(VGB),which was closed by suture ligation.This rat cholelithiasis model was examined by MRI,clinical observation,microcholangiography and histology.RESULTS:All rats survived two laparotomies.After ligation,the CBD was dilated to a stable size of 4 to30 mm in diameter on day 21-28,which became a VGB.The rats initially showed signs of jaundice that diminished over time,which paralleled with the evolving TSB levels from 0.6±0.3 mg/d L before ligation,through a peak of 10.9±1.9 mg/dL on day 14,until a nearly normalized value after day 28.The dilated CBD with thickened wall allowed an incision for implantation of human gallstones of 1-10 mm in diameter.The rat cholelithiasis was proven by in vivo MRI and postmortem microcholangiography and histomorphology.CONCLUSION:A rat model cholelithiasis with human gallstones has been established,which proves feasible,safe,reliable,nontoxic and cost-effective.Given the gallstones of human origin,applications of this model may be of help in translational research such as optical detection and lysis of gallstones by systemic drug administration.

Prevalence and characteristics of gallstone disease in an Iranian population:a study on cadavers

BACKGROUND:The prevalence of gallstones is low in Asians.In Iran,many factors influence the prevalence of this disease.The aim of this study was to determine the prevalence of gallbladder stones and their chemical characteristics in a population by the study of cadavers. METHODS:In this cross-sectional study,autopsies were performed on 253 cadavers of more than 13 years old.The cadavers were studied to determine the number,location of stone formation,chemical composition,dry weight,and mean diameter of stones in the gallbladder and common bile duct. RESULTS:The prevalence of gallstone disease in these cadavers was 6.3%(men 4.7%,women 8.6%,not significantly different,P=0.216).There was a positive relationship between the age and prevalence of gallstone disease(P=0.033).The most common stone compositions were cholesterol and oxalate.The mean diameter (P=0.0058)and dry weight(P<0.0001)of stones were higher in the gallbladder than in the common bile duct. Positive relations between the amount of oxalate and mean diameter,and between the amount of oxalate and mean dry weight of gallstones were found,but the relationship between the amount of cholesterol and mean diameter was inverse. CONCLUSIONS:The prevalence of gallstones differed among age groups.Diameter and dry weight of gallstones were dependent on location of stone formation and chemical composition.

LC+LERV与LC+LCBDE治疗胆囊结石合并胆总管结石的临床效果比较

目的通过对比分析腹腔镜胆囊切除术(LC)+腹腔镜术中联合内镜(LERV)与LC+腹腔镜胆总管切开取石(LCBDE)对胆囊结石合并胆总管结石的临床疗效,探讨两种手术方式的临床应用价值。方法前瞻性分析2021年12月至2023年5月江油市人民医院和潍坊市人民医院收治的110例胆囊结石合并胆总管结石患者的临床资料,按随机数字表法分为LC+LERV组(n=54)和LC+LCBDE组(n=56),对两组患者的手术成功率、术中出血量、手术时间、引流管留置时间、术后并发症、疼痛视觉模拟评分(VAS)、平均住院时间以及住院费用进行比较分析。结果与LC+LCBDE组相比,LC+LERV组手术成功率较低[47(87.04%)vs 56(100.00%),χ2=7.467,P=0.006],手术时间较长[(112.0±15.6)min vs(98.0±21.5)min,t=3.771,P<0.001],但引流管留置时间明显较短[(2.34±0.66)d vs(7.41±12.88)d,t=-2.693,P=0.008],两组比较差异均具有统计学意义(P<0.05)。两组在术中出血量、术后并发症发生率方面比较,差异无统计学意义(P>0.05);两组在术前、术后6 h、术后1 d及出院日VAS评分差异无统计学意义(P>0.05),但术后3 d LC+LCBDE组VAS评分高于LC+LERV组(P<0.05)。两组平均住院时间差异无统计学意义(P>0.05),但LC+LERV组平均住院费用明显高于LC+LCBDE组[(25653.6±3317.0)元vs(17978.4±2158.0)元,t=14.219,P<0.001]。结论在治疗胆囊结石合并胆总管结石方面,LC+LCBDE和LC+LERV安全性上表现一致,LC+LERV术后舒适性更佳,但LC+LCBDE在治疗有效性、经济效率性方面更好,且LC+LCBDE可作为LC+LERV插管或取石失败后的补救术式。根据具体病情个性化选择手术方式,有利优势互补,获得最佳治疗效果。

老年胆囊结石合并胆总管结石患者腹腔镜微创取石术后发生胰腺炎的危险因素及其预测效能

目的探讨老年胆囊结石(GS)合并胆总管结石(CBDS)患者腹腔镜微创取石术后发生胰腺炎的危险因素及预测效能。方法选择南阳市中心医院2020年1月至2023年1月收治的行腹腔镜微创取石术治疗的372例老年GS合并CBDS患者,根据术后是否发生胰腺炎分为胰腺炎组和非胰腺炎组。单因素和二元logistic回归分析老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎的危险因素。结果372例老年GS合并CBDS患者行腹腔镜微创取石术后胰腺炎发生率为13.71%。胰腺炎组乳头旁憩室、胰管显影、行胰管括约肌切开术、胰腺支架与鼻胆管引流患者占比分别为68.63%、76.47%、58.82%、45.10%,高于非胰腺炎组的33.33%、34.89%、19.31%、21.50%(P<0.05)。乳头旁憩室、胰管显影、胰腺支架与鼻胆管引流、行胰管括约肌切开术为老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎的独立危险因素(P<0.05)。logistic回归模型对老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎的曲线下面积为0.860(95%CI:0.792~0.933),敏感度为90.20%,特异度为67.29%。结论老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎风险较高,主要与乳头旁憩室、胰管显影、胰腺支架与鼻胆管引流、行胰管括约肌切开术等因素有关,基于上述因素构建预测模型具有良好预测效能,对上述危险因素进行针对性预防干预,可减少术后胰腺炎的发生,改善患者的预后。

胆囊功能预测内镜治疗胆总管结石术后并发症的价值

目的探讨胆囊功能预测内镜治疗胆总管结石术后并发症的价值。方法选取2018年1月-2022年12月该院行内镜清除术后胆囊完整的胆总管结石患者118例。患者肝功能恢复正常后,接受脂餐超声检查,以评估禁食容量、剩余容量和胆囊排空分数(GBEF)。分析胆总管结石患者临床特征和胆囊功能与复发性胆道并发症的关系。结果118例胆总管结石患者中,86例合并胆囊结石,32例未合并胆囊结石。随访期间,23例患者发生胆道并发症。86例合并胆囊结石患者中,15例胆囊结石自发清除,14例因急性胆囊炎或反复绞痛接受胆囊切除术。6例因非胆道原因死亡。多数胆囊结石患者GBEF明显降低。合并胆囊结石、饮酒和内镜清理胆管疗程超过1次,是内镜治疗胆总管结石术后胆道并发症复发的危险因素。结论合并胆囊结石的胆总管患者,GBEF较差。合并胆囊结石、饮酒和内镜清理胆管疗程超过1次,是内镜治疗胆总管结石术后胆道并发症复发的危险因素。由于胆囊结石可能自发清除,胆总管结石内镜治疗后,对胆囊进行保守监测是合适的,但有必要对复发风险高的患者进行定期随访。

胆囊结石合并胆总管多发结石治疗效果及其logistic回归分析

目的:基于logistic回归分析胆囊结石合并胆总管多发结石治疗效果及其影响因素,为临床防治提供参考依据。方法:选取2020年1月—2022年1月南阳市第一人民医院收治的150例胆囊结石合并胆总管多发结石患者作为研究对象,均行腹腔镜胆囊切除(LC)联合腹腔镜胆总管探查(LCBDE)术,随访1年,根据术后是否复发进行分组,对两组相关因素进行单因素和多因素非条件的logistic回归分析。结果:随访显示,150例胆囊结石合并胆总管多发结石患者中,术后有18例结石残留,残留率为12.00%(18/150);术后37例复发,纳入观察组,复发率为24.67%(37/150),未复发113例,纳入对照组。观察组胆固醇水平、胆总管直径、乳头旁憩室、胰管反复显影、胆管角成角、合并炎症患者比例高于对照组,差异有统计学意义(χ^(2)=4.745、7.037、15.270、10.784、20.156、23.180,P<0.05)。胆固醇水平(>5.72 mmol/L)、胆总管直径(≥1.5 cm)、乳头旁憩室、胰管反复显影、合并炎症是胆囊结石合并胆总管多发结石术后复发危险因素,胆总管成角(>120°)是保护因素。结论:胆固醇水平、胆总管直径、乳头旁憩室、胰管反复显影、胆管角、合并炎症是胆囊结石合并胆总管多发结石术后复发的影响因素,临床应重视此类患者的术前评估及术后操作,以降低术后结石复发风险。

“三镜”联合手术治疗老年与非老年胆总管结石合并胆囊结石的效果对比

目的探讨腹腔镜、胆道镜及十二指肠镜三镜联合微创手术对老年胆总管结石合并胆囊结石病人的治疗效果。方法回顾性分析自2020年9月至2022年7月因胆总管结石合并胆囊结石就诊于华中科技大学同济医学院附属协和医院,同期行腹腔镜、胆道镜及十二指肠镜三镜联合手术的病人,总计65例病人纳入本研究,男性36例,女性29例,年龄范围为20~87岁。其中老年组(年龄≥60岁)病人32例,非老年组(年龄<60岁)病人33例。收集病人手术时间、术中出血量、胆总管直径、术后住院时间、术后并发症、手术费用等临床数据。结果老年组总住院时间高于非老年组[(14.5±3.6)d比(12.5±4.3)d,P<0.05],在手术时间、术中出血量、首次进食时间、术后住院时间、住院费用及术后总并发症[12.5%(4/32)比6.1%(2/33)]方面,差异均无统计学意义(均P>0.05)。结论“三镜”联合术式在老年胆总管结石合并胆囊结石病人和非老年胆总管结石合并胆囊结石病人中效果无明显差异,对老年病人是一种安全、有效的术式。

腹腔镜胆囊切除联合胆道镜经胆囊管探查取石术对胆囊合并胆总管结石患者手术相关指标及并发症的影响

目的探讨腹腔镜胆囊切除(LC)联合胆道镜经胆囊管探查取石术(LTCBDE)治疗胆囊合并胆总管结石患者的应用价值。方法选取2020年8月至2022年8月我院收治的96例胆囊合并胆总管结石患者为研究对象,基于随机数字表法规范化分为两组各48例,对照组实行开腹手术,观察组实行微创手术即LC+LTCBDE,观察对比两组手术相关指标、术后并发症发生率、炎症因子水平、肝功能指标。结果与对照组做对比,观察组术中出血量低,手术用时短,术后下床活动、肛门排气及住院时间均更短(P<0.05);与对照组做对比,观察组术后并发症发生率低(P<0.05);术后3d,两组CRP、IL-6、TNF-α、AMY水平均升高,其中观察组较对照组相对低(P<0.05);术后,两组AST、ALT、TBi L、ALP水平均升高,且术后3d观察组以上指标均较对照组低(P<0.05)。结论胆囊合并胆总管结石患者实施LC+LTCBDE治疗,相较于开腹胆囊切除胆总管探查术(OCBDE),患者损伤小,便于恢复,且并发症风险低,加快术后康复进程,其治疗安全性及有效性兼顾。

内镜鼻胆囊引流治疗胆总管结石合并急性化脓性胆囊炎

目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。

腹腔镜联合胆道镜经胆囊管胆道探查取石术与胆总管切开取石术治疗胆囊结石合并胆管结石患者疗效研究

目的比较研究腹腔镜联合胆道镜经胆囊管胆道探查取石术(LTCBDE)与腹腔镜胆总管切开取石术(LCBDE)治疗胆囊结石(GS)合并肝外胆管结石(EBDS)患者的疗效。方法2022年1月~2024年1月我院收治的GS合并EBDS患者168例,其中对照组123例接受LCBDE)手术,观察组45例接受LTCBDE手术治疗。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白介素(IL)-6和C反应蛋白(CRP),常规检测血生化指标。结果观察组手术时间、术中出血量、肛门排气时间、术后住院日和医疗花费分别为(104.4±34.2)min、(29.9±11.2)ml、(22.3±10.1)h、(6.5±2.9)d和(1.4±0.6)万元,均显著短于或少于对照组【分别为(149.9±37.4)min、(43.6±16.3)ml、(28.4±9.6)h、(9.2±2.4)d和(1.8±0.7)万元,P<0.05】,两组结石清除率均为100.0%;在术后3d,观察组血清肿瘤坏死因子-α和白介素-6水平分别为(32.5±5.9)ng/L和(25.4±7.1)pg/L,均显著低于对照组【分别为(40.3±6.8)ng/L和(35.6±6.4)pg/L,P<0.05】;术后观察组胆漏、胆道感染、腹腔感染、胆道出血和急性胰腺炎发生率分别为0.0%、2.2%、2.2%、0.0%和0.0%,与对照组的2.4%、0.0%、4.1%、1.6%和2.4%比,差异均无统计学意义(P>0.05)。结论LCBDE与LTCBDE手术治疗GS合并EBDS患者均具有较好的清除结石效果,但在术后恢复和花费成本方面,LTCBDE手术更显优异。

熊去氧胆酸片对胆囊合并胆总管结石术后老年患者肝功能及胆汁成分的影响

目的探讨熊去氧胆酸片对胆囊合并胆总管结石术后老年患者肝功能及胆汁成分的影响。方法选取医院2021年2月至2023年2月收治的胆囊合并胆总管结石并行腹腔镜胆囊切除术联合消化内镜逆行性胰胆管造影术的老年(年龄不低于60岁)患者120例,按随机数字表法分为观察组和对照组,各60例。术后,对照组患者予常规治疗注射用头孢噻肟钠和异苷草酸镁注射液,观察组患者在对照组治疗基础上加用熊去氧胆酸片,两组患者均治疗3周。结果治疗后,两组患者的胆囊壁厚度均显著变小(P<0.05),胆囊收缩率均显著升高(P<0.05),且观察组均显著优于对照组(P<0.05);两组患者的丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平均显著降低(P<0.05),且观察组均显著低于对照组(P<0.05);两组患者的胆汁总胆固醇、总胆红素水平均显著降低(P<0.05),总胆汁酸水平均显著升高(P<0.05),且观察组均显著优于对照组(P<0.05)。术后2个月,观察组患者的腹胀、右上腹不适、胆绞痛等临床症状消失率均显著高于对照组(95.00%比61.67%,88.33%比68.33%,100.00%比76.67%,P<0.05)。术后1,6,12个月,观察组患者的结石复发率均显著低于对照组(0比1.67%,3.33%比8.33%,3.33%比18.33%,P<0.05)。结论熊去氧胆酸片可有效改善胆囊合并胆总管结石术后老年患者的肝功能及胆汁成分,减轻患者的临床症状,增强胆囊功能,减少结石复发。

腹腔镜胆囊切除术联合胆总管探查术后一期缝合与内镜逆行胰胆管造影治疗老年胆囊结石合并胆总管结石的效果

目的探究腹腔镜胆囊切除术(LC)联合胆总管探查术后一期缝合与内镜逆行胰胆管造影(ERCP)治疗老年胆囊结石合并胆总管结石的效果。方法回顾性分析2020年1月至2022年7月贵州航天医院收治的91例老年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组(经LC联合胆总管探查术后一期缝合治疗,n=47)和ERCP组(经ERCP治疗,n=44),比较两组围手术期指标、术后并发症发生情况及疼痛应激指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、5-羟色胺(5-HT)、去甲肾上腺素(NE)]。结果LC组手术时间及术后禁食时间均长于ERCP组,住院时间短于ERCP组,差异有统计学意义(P<0.05);两组术中出血量比较差异无统计学意义。LC组胃肠道反应、胰腺炎发生率均低于ERCP组,胆漏发生率高于ERCP组,差异有统计学意义(P<0.05);两组黄疸、术后出血发生率比较差异无统计学意义。术后3 d,两组CRP、IL-6、5-HT、NE水平均高于术前,差异有统计学意义(P<0.05);术前及术后3 d,两组CRP、IL-6、5-HT、NE水平比较差异无统计学意义。结论与ERCP相比,LC联合胆总管探查术后一期缝合不仅可缩短住院时间,还可保留患者Oddis括约肌功能,且术后并发症未见明显增加,值得临床推广应用。

ERCP联合LC同期手术在治疗老年胆囊胆总管结石的临床研究

目的探讨内镜逆行胰胆管造影(ERCP)联合腹腔镜胆囊切除术(LC)同期手术在治疗老年胆囊结石合并胆总管结石患者中的疗效及临床意义。方法去回顾我院2019年8月至2023年月12收治的86例老年胆囊结石合并胆总管结石病例资料,均采用ERCP联合LC手术治疗,依据不同手术方式分为ERCP联合LC同期手术(A组)及ERCP术后3~5天序贯LC(B组)两组,比较两种治疗方式的手术时间、取石成功率、术后并发症发生率、住院时间、治疗费用等。结果A组40例患者均手术成功,ERCP平均时间37min,LC平均时间41min,平均住院时间9d,平均住院费用3.6万;ERCP术后并发症4例:急性胰腺炎3例、胆管炎0例、十二指肠乳头出血1例、十二指肠穿孔0例。B组46例患者均手术成功ERCP平均时间39min,LC平均时间46min,差异无统计学意义(P>0.05)。平均住院时间12d,平均住院费用约4万,差异有统计学意义(P<0.05)。ERCP术后并发症5例:急性胰腺炎3例、胆管炎1例、十二指肠乳头出血1例、十二指肠穿孔0例,与A组差异无统计学意义(P>0.05)。结论在合理选择患者的前提下,ERCP联合LC同期手术微创治疗胆囊合并胆总管结石在老年患者中是安全可行的,与分期序贯手术相比具有住院时间短及总体住院费用下降,且不增加并发症发生率的优势;与腹腔镜胆囊切除、胆总管切开取石及T管引流(LCBDE)相比,增加了患者术后舒适度,维持了胆总管完整性,值得推广。

腹腔镜联合胆道镜经胆囊管治疗胆总管结石的效果及安全性分析

目的探究在胆总结石患者治疗中,腹腔镜与胆道镜经胆囊管治疗的效果及其安全性。方法非随机选取2020年11月—2023年11月于南京市江宁中医院治疗的89例胆总管结石患者为研究对象,根据治疗方法不同分为对照组与观察组。对照组44例患者实施开腹胆囊切除术与胆囊管切开取石术联合治疗,观察组45例患者实施腹腔镜胆囊切除术与胆道镜经胆囊管取石术治疗。比较两组手术指标、临床指标水平、并发症发生情况及生活质量评分。结果观察组术中出血量少于对照组,手术时间短于对照组,切口长度小于对照组,差异有统计学意义(P均<0.05)。观察组临床指标水平优于对照组,差异有统计学意义(P均<0.05)。观察组并发症发生率为2.22%(1/45),低于对照组的15.91%(7/44),差异有统计学意义(χ^(2)=5.094,P<0.05)。治疗后观察组生活质量评分高于对照组,差异有统计学意义(P<0.05)。结论在胆总管结石患者治疗中,腹腔镜与胆道镜胆囊管手术联合治疗的效果较好,且并发症发生率低,术后生活质量较高。