一期腹腔镜胆囊切除联合腹腔镜胆总管探查取石术治疗胆囊结石合并胆总管结石的清石效果观察

doi:10.3969/j.issn.1005-6483.2021.06.018

摘要/Abstract

摘要： 目的：探讨一期腹腔镜胆囊切除(LC)联合腹腔镜胆总管探查取石术(LCBDE)治疗胆囊结石合并胆总管结石的清石效果。方法：2018年2月~2020年2月收治的胆囊结石合并胆总管结石病人110例，按照取石方式的不同分为对照组观察组，每组各55例。对照组采用LC联合乳头括约肌切开取石术(EST)或内镜逆行胰胆管造影(ERCP)，观察组采用LC联合LCBDE治疗，术后7天评估临床效果，比较两组手术相关指标、机体免疫细胞水平、并发症及取石效果。结果：观察组手术时间、术中出血量、术后7天疼痛程度评分、肛门排气时间、卧床时间、住院时间以及住院费用，均低于对照组，差异有统计学意义(P<0.05)；观察组治疗后7天CD3+、CD4+、CD8+以及CD4+/CD8+水平低于对照组；观察组治疗后胆道出血、感染、胆漏及血淀粉酶升高的发生率低于对照组，差异有统计学意义(P<0.05)。观察组治疗后取石成功率及结石完全清除率高于对照组，差异有统计学意义(P<0.05)。结论：胆囊结石合并胆总管结石采用一期LC联合LCBDE取石治疗效果较好，胆结石的清除较为彻底，降低并发症的风险。

关键词: 腹腔镜胆囊切除术, 乳头括约肌切开取石术/内镜逆行胰胆管造影, 腹腔镜胆总管切开取石术

Abstract: Objective：To investigate the effect of onestage laparoscopic cholecystectomy(LC) combined with laparoscopic common bile duct exploration(LCBDE) in the treatment of gallbladder stones combined with common bile duct stones.Methods：Select 110 patients with gallbladder stones and choledocholithiasis who were admitted from February 2018 to February 2020,and were divided into control group(n=55 cases) and observation group(n=55 cases) according to different methods of stone removal.The control group was treated with LC combined with papillary sphincterotomy(EST) or endoscopic retrograde cholangiopancreatography(ERCP),and the observation group was treated with LC combined with LCBDE.The patient's effect was evaluated 7 days after surgery,and the two groups were compared with related surgical indicators and immune cells.Level,complications and effect of stone removal.Results：After treatment,the operation time,intraoperative blood loss,pain degree score,anal exhaust time,bed time,hospitalization time,and hospitalization expenses in the observation group were lower than those in the control group(P<0.05);after treatment in the observation group The 7 d CD3+,CD4+,CD8+ and CD4+/CD8+ levels were slightly lower than those of the control group;the incidence of biliary hemorrhage,infection,bile leakage and blood amylase elevation in the observation group after treatment was lower than that of the control group(P<0.05),the observation group The success rate of stone retrieval and complete stone removal rate after treatment were higher than those of the control group(P<0.05).Conclusion：Onestage LC combined with LCBDE for treatment of gallbladder stones with choledocholithiasis has a better effect.The removal of gallstones is more thorough,reduces the risk of complications,and obtains a good therapeutic effect.

Key words: laparoscopic cholecystectomy, papillary sphincter incision and lithography/endoscopic retrograde cholangiopancreatography, laparoscopic common bile duct incision and calculi

张吉祥, 张娟, 何希平等. 一期腹腔镜胆囊切除联合腹腔镜胆总管探查取石术治疗胆囊结石合并胆总管结石的清石效果观察[J]. 临床外科杂志, 2021, 29(6): 562-564.

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