目的:观察腹腔镜胆总管切开取石术(LCBDE)+腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石(CBDS)患者疗效及对术后并发症的影响,为临床治疗提供循证医学参考.方法:选取2019年1月—2023年1月样本医院肝胆外科收治的68例CBDS患者作为研究对象,按手术方式分为LCBDE+LC组和行经内镜逆行性胰胆管造影术(ERCP)/经十二指肠镜Oddi括约肌切开术(EST)+LC组,每组各34例.比较两组患者围手术期指标和术后并发症发生率,记录两组患者术前1 d及术后3 d炎症反应[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、P物质(P)]和免疫功能(CD4+、CD8+、CD4+/CD8+)情况.结果:LCBDE+LC组患者手术时间、术中出血量、术后排气时间、胆汁引流时间、卧床时间、住院时间明显少于ERCP/EST+LC组,结石完全清除率明显高于ERCP/EST+LC组,差异有统计学意义(t=2.314、4.623、3.198、2.225、2.214、4.012;x2=4.221,P＜0.05);术后 3d,两组患者 IL-6、TNF-α 和 P 水平明显升高,但 LCBDE+LC 组患者低于ERCP/EST+LC组,两组患者CD4+、CD8+水平和CD4+/CD8+明显降低;LCBDE+LC组与ERCP/EST+LC组患者术后并发症总发生率分别是14.71％和20.59％,差异无统计学意义(x2=0.405,P＞0.05).结论:LCBDE+LC治疗胆囊结石合并胆总管结石相较于ERCP/EST+LC更有助于确保结石完全清除,且创伤更小术后恢复更快,可减轻患者炎症反应.
Efficacy of LCBDE+LC on Patients with Cholecystolithiasis and Common Bile Duct Stone and its Influence on Postoperative Complications
Objective:To observe the efficacy of laparoscopic common bile duct exploration+laparoscopic cholecystectomy(LCBDE+LC)in the treatment of patients with cholecystolithiasis complicated with common bile duct stone(CBDS)and its influence on postoperative complications,and to provide evidence-based medical reference for clinical treatment.Methods:68 patients with CBDS in department of hepatobiliary surgery of the hospital from January 2019 to January 2023 were included in the study,and they were divided into two groups according to different surgical methods.Among the patients,34 cases who underwent LCBDE+LC were selected as LCBDE+LC group,and 34 cases who underwent endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy(EST)+LC were classified as ERCP/EST+LC group.The differences in perioperative indicators and incidence rates of postoperative complications were compared between the two groups.The inflammatory response[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),substance P(P)]and immune function(CD4+,CD8+,CD4+/CD8+)were recorded and compared between both groups 1 day before surgery and 3 days after surgery.Results:The operative time,intraoperative blood loss,postoperative exhaust time,bile drainage time,bed time and hospital stay in LCBDE+LC group were significantly lower than those in ERCP/EST+LC group,and the total stone clearance rate was significantly higher than that in ERCP/EST+LC group.The difference was statistically significant(t=2.314,4.623,3.198,2.225,2.214,4.012;x2=4.221;P＜0.05).At 3 days after surgery,the levels of IL-6,TNF-α and P in the two groups were significantly increased,but the levels of CD4+,CD8+and CD4+/CD8+in the LCBDE+LC group were lower than those in the ERCP/EST+LC group,and the levels of CD4+and CD8+were significantly decreased in the two groups.The total incidence of postoperative complications in LCBDE+LC group and ERCP/EST+LC group was 14.71％and 20.59％,respectively,with no significant difference(x2=0.405,P＞0.05).Conclusion:LCBDE+LC treatment of patients with cholecystolithiasis complicated with CBDS can better remove stone,with less trauna and better recovery.It can reduce inflammation of patients.
CholecystolithiasisCommon bile duct stoneLaparoscopic cholecystectomyLaparoscopic common bile duct explorationClinical efficacyPostoperative complications
万方数据
维普
