经内镜逆行胰胆管造影术取石术联合腹腔镜治疗胆囊结石合并肝外胆管结石的临床疗效研究

doi:10.3969/j.issn.1006-6233.2022.01.028

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摘要 目的:探究经内镜逆行胰胆管造影术(ERCP)+取石术将肝外胆管的结石取出后,再行腹腔镜将胆囊切除胆管结石的临床疗效。方法:选取2019年1月至2020年1月云南省第一人民医院采取传统外科手术及经内镜逆行胰胆管造影术(ERCP)+取石术将肝外胆管的结石取出后,再行腹腔镜将胆囊切除的患者共98例,随机分为两组,其中每一种术式49例,观察组采用经内镜逆行胰胆管造影术(ERCP)+取石术将肝外胆管的结石取出后,再行腹腔镜将胆囊切除,对照组采用传统外科手术治疗。比较两组患者临床疗效、手术情况、术后疼痛程度和并发症发生情况。结果:观察组结石完全清除率显著高于对照组(χ²=9.910,P<0.05),观察组使用镇痛药比例显著低于对照组(χ²=7.127,P<0.05),观察组患者手术时间、术中出血量、术后通气时间、住院时间均显著小于对照组(t=14.239、8.068、8.476、3.863,P<0.05),两组患者术前VAS评分无统计学差异,术后两组患者VAS评分均价术前明显降低(P<0.05),且观察组VAS评分显著低于对照组(F=6.341、10.759,P<0.05),观察组并发症发生率显著低于对照组(χ²=6.078,P<0.05)。结论:非急诊手术患者采取经内镜逆行胰胆管造影术(ERCP)+取石术将肝外胆管的结石取出后,再行腹腔镜将胆囊切除,此方法疗效显著,患者预后较好且不良反应明显减少。

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关键词 ：胆囊结石, 肝外胆管结石, 内镜逆行胰胆管造影术, 取石术, 腹腔镜

Abstract：Objective: To explore the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) + lithotomy in removing extrahepatic bile duct stones, and then laparoscopic cholecystectomy for bile duct stones. Methods: A total of 98 patients with extrahepatic bile duct stones removed by traditional surgery and endoscopic retrograde cholangiopancreatography (ERCP) + choledocholithotomy in the first people's Hospital of Yunnan Province from January 2019 to January 2020 were collected and divided into two groups, 49 cases for each operation. The experimental group was treated by endoscopic retrograde cholangiopancreatography (ERCP) + choledocholithotomy. The control group underwent the traditional surgery. The clinical efficacy, operation, postoperative pain and complications of the two groups were compared. Results: The complete stone clearance rate of the experimental group was higher than that of the control group (χ²=9.910, P<0.05), and the proportion of analgesics used in the experimental group (χ²=7.127, P<0.05), the postoperative ventilation stay of the experimental group were significantly less than those of the control group (t=14.239, P<0.05). There difference of VAS score between the two groups before operation was not significant, but the average VAS score of the two groups decreased significantly after operation (P<0.05), and the VAS score of the experimental group (t=6.341, 10.759, P<0.05) was lower than that of the control group(χ²=6.078, P<0.05). Conclusion: Non-emergency operation patients take ERCP + lithotomy, and then laparoscopic cholecystectomy. This method has significant curative effect, good prognosis and less adverse reactions.

Key words： Cholecystolithiasis Extrahepatic bile duct stones ERCP Lithotomy Laparoscope

基金资助:云南省临床医学中心开放项目项目,(编号:2020LCZXKF-XH12)

通讯作者: 娄兴旖

引用本文:

苏彬, 娄丽华, 张诗彤, 刘森, 杜留锁, 赵靓雯, 李智成, 娄兴旖. 经内镜逆行胰胆管造影术取石术联合腹腔镜治疗胆囊结石合并肝外胆管结石的临床疗效研究[J]. 河北医学, 2022, 28(1): 137-140.
SU Bin, et al. Research on the Clinical Effecacy of the Combination Therappy of Endoscopic Retrograde Cholangiopancreatographp (ERCP) Lithotomy and Laparoscope in Treating Gallstone Combined with Extrahepatic Biliary Duct Stone. HeBei Med, 2022, 28(1): 137-140.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.01.028 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I1/137

[1] 裴赛丽,王震宇.腹腔镜联合十二指肠镜与胆总管一期缝合治疗胆囊合并胆总管结石的疗效比较[J].中华消化内镜杂志,2020,37(6):435~440.
[2] Mbatshi G,Macken EJ,De Schepper HU,et al.Comparison of side-viewing duodenoscope and single-balloon enteroscope toperform ERCP in patients with Billroth II gastrectomy[J].Acta Gastroenterol Belg,2017,80(4):493~497.
[3] Loor MM,Morancy JD,Glover JK,et al.Single-settingendoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomyimprove the rate of surgical site infection[J].Surg Endosc,2017,31(12):5135~5142.
[4] 肖林康,吴堃,向吉锋,等.三镜联合胆道支架胆总管一期缝合治疗肝外胆管结石的临床研究[J].重庆医科大学学报,2019,44(9):1224~1228.
[5] Smith S,Stagg J,Naumann C.Single-balloon enteroscopic retrogradecholangiopancreatography in the setting of altered upper gastrointestinalanatomy[J].Proc (Bayl Univ Med Cent),2018,31(4):467~469.
[6] Yu M,Xue H,Shen Q,et al.Primary closure following laparoscopic common bile duct exploration combined with intraoperative choledochoscopy and D-J tube drainage for treating choledocholithiasis[J].Med SciMonit,2017,23(9):4500~4505.
[7] Mohammad B,Richard MN,Pandit A,et al.Outcomes oflaparoscopic-assisted ERCP in gastric bypass patients at a community hospitalcenter[J].Surg Endosc,2020,34(12):5259~5264.
[8] Hu L,Chai Y,Yang X,et al.Duodenoscope combined withlaparoscopy in treatment of biliary stones for a patient with situs inversustotalis:a case report[J].Medicine (Baltimore),2019,98(7):e14272.
[9] Rosen JD,Lane RS,Martinez JM,et al.Success and safety of endoscopic retrogradecholangiopancreatography in children[J].Pediatr Surg,2017,52(7):1148~1151.
[10] Huang YH,Chang H,Yao W,et al.A snare-assisted peroraldirect choledochoscopy and pancreatoscopy using an ultra-slim upper endoscope:acase series study[J].Dig Liver Dis,2017,49(6):657~663.
[11] Wang XS,Wang F,Li QP,et al.Endoscopic retrogradecholangiopancretography in modified double tracks anastomosis with anastomoticstenosis[J].World Gastrointest Endosc,2017,9(3):145~148.