摘要
目的对比腹腔镜胆囊切除术(LC)联合同期内镜逆行胰胆管造影术(ERCP)、LC联合腹腔镜胆总管探查取石术(LCBDE)治疗高龄胆囊结石合并继发性胆总管结石(CBDS)患者的效果。方法选取南阳市第一人民医院2020年3月至2022年9月接收的122例高龄胆囊结石合并CBDS患者,随机分为ERCP+LC组、LCBDE+LC组,各61例。比较两组手术指标、手术前后炎症指标[C反应蛋白(CRP)、白细胞介素(IL-6)]、肝功能指标[总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、淀粉酶(AMS)]、术后并发症状况。结果ERCP+LC组手术时长、住院时长、术后首次排气时间、首次下床时间短于LCBDE+LC组,术中总失血量少于LCBDE+LC组(P<0.05)。ERCP+LC组结石清除率(98.36%)高于LCBDE+LC组(86.89%)(P<0.05);术后1 d,ERCP+LC组血清CRP、IL-6水平低于LCBDE+LC组(P<0.05);术后1 d,ERCP+LC组血清TBIL、AMS、AST、ALT水平均低于LCBDE+LC组(P<0.05);ERCP+LC组术后并发症总发生率与LCBDE+LC组对比,差异无统计学意义(P>0.05)。结论LC联合同期ERCP治疗高龄胆囊结石合并CBDS患者具有较高的结石清除率,手术创伤较小,炎症反应较轻,可有效保护患者肝功能,促进高龄患者术后快速康复。
Objective To compare the effect of laparoscopic cholecystectomy(LC)combined with simultaneous endoscopic cholangiopancreatography(ERCP),LC combined with laparoscopic choledocholithotomy(LCBDE)for elderly patients with cholecystolithiasis and secondary common bile duct stone(CBDS).Methods A total of 122 elderly patients with cholecystolithiasis and secondary CBDS admitted to the First People’s Hospital of Nanyang City from March 2020 to September 2022 were selected and randomly divided into ERCP+LC group and LCBDE+LC group by number table method,with 61 cases in each group.Operative indexes,inflammatory indexes[C-reactive protein(CRP),interleukin-6(IL-6)],liver function indexes[total bilirubin(TBIL),aspartate aminotransferase(AST),alanine amylase(ALT),amylase(AMS)]before and after operation and postoperative complications were compared between two groups.Results The operation time,hospitalization time,the first postoperative exhaust time and the first time of getting out of bed in ERCP+LC group were shorter than those in LCBDE+LC group,and the total intraoperative blood loss was lower than that in LCBDE+LC group(P<0.05).The stone clearance rate in the ERCP+LC group(98.36%)was higher than that in LCBDE+LC group(86.89%)(P<0.05).After 1 day of surgery,serum levels of CRP and IL-6 in ERCP+LC group were lower than those in LCBDE+LC group(P<0.05).After 1 day of surgery,serum levels of TBIL,AMS,AST and ALT in ERCP+LC group were obviously lower than those in the LCBDE+LC group(P<0.05).There was no statistical difference in the total incidence of postoperative complications between ERCP+LC group and LCBDE+LC group(P>0.05).Conclusion LC combined with simultaneous ERCP for elderly patients with cholecystolithiasis and secondary CBDS has a higher stone clearance rate,less surgical trauma and less inflammatory reaction,which can effectively protect the liver function of patients and promote rapid postoperative recovery in elderly patients.
作者
陈大勇
郭宏志
李权
吴金海
CHEN Dayong;GUO Hongzhi;LI Quan(Department of Hepatobiliary Pancreatology and Spleen Surgery,the First People’s Hospital of Nanyang,Nanyang 473000,China)
出处
《河南医学研究》
CAS
2024年第6期1060-1063,共4页
Henan Medical Research
