LC_联合ERCP_和EST_治疗胆囊结石合并肝外胆管结石患者疗效研究.pdf

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实用肝脏病杂志2023年5月第26卷第3期JPracHepatol,May.2023.Vol.26No.3
·胆石症·

LC联合ERCP和EST治疗胆囊结石合并
肝外胆管结石患者疗效研究∗

吴正东,徐刚,慕海峰,陈升宝,班坤锋

【摘要】目的分析比较内窥镜逆行胰胆管造影术(ERCP)联合内窥镜下括约肌切开术(EST)后何时进行腹腔镜

胆囊切除术(LC)治疗胆囊结石合并肝外胆管结石患者更有效且安全。方法2019年4月~2022年4月我院收治的65
例胆囊结石合并肝外胆管结石患者,被随机分为两组,均首先接受ERCP联合EST术治疗,其中35例观察组患者在ERCP
联合EST术后48h内行LC术,另30例对照组患者在ERCP联合EST术后48~72h内行LC术。采用免疫比浊法检测血
清C反应蛋白(CRP),采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平。结果观察组术中出
血量、术后住院日和住院费用分别为(15.6±2.3)ml、(8.3±0.9)d和(1.9±0.2)万元,显著少于或短于对照组【分别为
(34.7±4.1)ml、(12.3±1.5)d和(2.4±0.3)万元,P<0.05】,而两组LC手术时间、中转开腹率和结石清除率比较,无显著

性差异(P>0.05);术前术后,两组血清TBIL、AST、ALT和ALB水平无显著性差异(P>0.05);术后,观察组外周血WBC计
×
数和血清CRP水平分别为(14.3±1.7)×109/L和(25.5±2.3)mg/L,显著高于对照组【分别为(12.8±2.5)109/L和(18.7
±3.4)mg/L,P<0.05】,而两组血清IL-6和TNF-α水平无显著性相差【分别为(33.1±6.5)μg/L和(21.8±2.7)μg/mL对
(36.8±38.2)μg/L和(20.2±3.1)μg/mL,P<0.05】;术后,两组并发症,如胆管炎、切口感染、胆道出血、胆漏和胰腺炎等发

生率比较无显著性差异(8.6%对23.3%,P>0.05)。结论在采取ERCP联合EST术治疗肝外胆管结石患者后尽早进行
LC术可缩短住院时间,减少医疗花费,值得进一步探索。
【关键词】胆囊结石;肝外胆管结石;腹腔镜胆囊切除术;内窥镜逆行胰胆管造影术;内窥镜下括约肌切开术;治疗
DOI:10.3969/j.issn.1672-5069.2023.03.033

EarlyLCafterERCPandESTisbeneficialinthetreatmentofpatientswithsimultaneousgallbladderandextrahepatic
bileductstonesWuZhengdong,XuGang,MuHaifeng,etal.DepartmentofGeneralSurgery,TongrenHospital,Southeast
UniversitySchoolofMedicine,Nanjing222200,JiangsuProvince,China
【Abstract】ObjectiveTheaimofthisstudywastoinvestigatewhethertheearlylaparoscopiccholecystectomy(LC)after
endoscopicretrogradecholangiopancreatography(ERCP)andendoscopicsphincterotomy(EST)isbeneficialinthetreatmentof
patientswithsimultaneousgallbladderandextrahepaticbileductstones.MethodsAretrospectiveanalysiswasperformedonthe
clinicaldataof65patientswithgallbladderandextrahepaticbileductstoneswhowereadmittedtoourhospitalbetweenApril2019
andApril2022,andallpatientsunderwentERCPandESTforremovalofbileductstonesfirstly.Afterthat,35patientsinthe
observationgroupreceivedLCwithin48h,andanother30patientsreceivedin48hto72hlater.SerumC-reactiveprotein
(CRP)andperipheralbloodwhitebloodcell(WBC)countswe