胆总管结石病人腹腔镜胆囊切除术联合内镜括约肌切开术术后并发症及其影响因素分析

doi:10.3969/j.issn.1005-6483.2019.06.013

摘要/Abstract

摘要： 目的分析腹腔镜胆囊切除术联合内镜括约肌切开术治疗胆总管结石后并发症情况，并分析其影响因素。方法胆总管结石病人136例，按实际治疗情况进行分组，对照组76例，行腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）。观察组60例，行LC联合内镜括约肌切开术（endoscopic sphincterotomy，EST），术后随访2年，观察病人并发症发生情况、检测Oddi括约肌（spincter of oddi，SO）压力和培养胆汁，筛选和分析可能影响术后并发症的因素。结果对照组并发症发生率高于观察组，但各并发症发生率比较差异无统计学意义（P>0.05），两组肝功能异常发生率比较差异无统计学意义（P>0.05）；两组胆总管（common bile duct，CBD）压力和SO基础压力均无明显变化（P>0.05），SO收缩幅度（amplitude of SO contractions，SOCA）和SO收缩频率（frequency of SO contractions，SOF）均明显降低（P<0.05）。术后，对照组感染率高于观察组（P<0.05），但两组细菌感染比例比较差异无统计学意义（P>0.05）；病程、胆囊结石、CBD内径、最大结石直径和细菌感染是影响CBD结石病人LC联合EST术后并发症的单因素（P<0.05）；病程＞5年、患有胆囊结石、CBD内径＞15mm、最大结石直径＞15mm和细菌感染是影响CBD结石病人LC联合EST术后并发症的独立危险因素（P<0.05）。结论 LC和EST联合治疗相较于单独手术，并未增加CBD结石病人术后并发症风险，病程＞5年、患有胆囊结石、CBD内径＞15mm、最大结石直径＞15mm和细菌感染是影响CBD结石病人LC联合EST术后并发症的独立危险因素。

关键词: 胆总管结石, 腹腔镜胆囊切除术, 内镜括约肌切开术, 并发症

Abstract:

Objective To explore the complications of laparoscopic cholecystectomy combined with endoscopic sphincterotomy in the treatment of gallbladder and analyze the influencing factors.Methods A retrospective analysis of 136 patients with biliary summary stones admitted to our hospital from April 2015 to April 2016 were divided into groups according to the actual treatment.The control group（n=76）underwent laparoscopic cholecystectomy（LC），the observation group（n=60）underwent LC combined with endoscopic sphincterotomy（EST）.All the patients were followed up for 2 years.The complications were observed，Oddi sphincter pressure and bile were detected，screening and analysis may affect postoperative Factors of complications.Results The incidence of complications in the control group was higher than that in the observation group，but the incidence of complications was not significant（P>0.05）.There was no significant difference in the incidence of liver dysfunction between the two groups（P>0.05）.There was no significant change in CBD pressure and SO base pressure（P>0.05），amplitude of SO contractions（SOCA）and frequency of SO contractions（SOF）.The incidence of the control group was significantly lower than that of the observation group（P<0.05），but the difference of bacterial infection rate between the two groups was not significant（P>0.05）.The course of disease and gallstones，CBD internal diameter，maximum stone diameter and bacterial infection were single factors affecting the complications of LC combined with EST in patients with choledocholith（P<0.05）; disease duration greater than 5 years，with gallstones，CBD internal diameter greater than 15 mm，maximum stones Diameter greater than 15 mm and bacterial infection were independent risk factors for the complications of LC combined with EST in patients with choledocholith（P<0.05）.Conclusion The combined therapy of LC and EST did not increase the risk of postoperative complications in patients with choledocholith，and the disease duration was greater than 5 years，with gallstones，CBD internal diameter greater than 15 mm and maximum stone diameter greater than 15 mm and bacterial infection were independent risk factors for the complications of LC combined with EST in patients with choledocholith.

Key words: choledocholith, laparoscopic cholecystectomy;endoscopic sphincterotomy;complications

郑兵, 王伟, 任锐, 朱涛, 芦灵军, 陆昌友. 胆总管结石病人腹腔镜胆囊切除术联合内镜括约肌切开术术后并发症及其影响因素分析[J]. 临床外科杂志, 2019, 27(6): 485-488.

ZHENG Bing, WANG Wei, REN Rui, et al.. Analysis of complications and influencing factors of patients with choledocholithiasis after LC combined with EST[J]. JOURNAL OF CLINICAL SURGERY, 2019, 27(6): 485-488.

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