LC联合腹腔镜下胆总管切开取石术治疗胆总管结石伴急性胆管炎合并胆囊结石的临床疗效观察

doi:10.3969/j.issn.1006-6233.2023.12.020

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摘要 目的: 探讨腹腔镜胆囊切除(LC)手术、胆总管切开取石术中采取一期缝合与T管引流治疗胆囊结石、胆总管结石伴急性胆管炎的效果差异。方法: 选取我院2020年1月至2022年12月确诊且需要实施手术的胆囊结石、胆总管结石伴急性胆管炎患者118例作为研究对象,采用随机临床试验将患者分为A组、B组各59例,A组患者采用LC手术+胆总管切开取石术联合一期缝合治疗,B组患者采用LC手术+胆总管切开取石术联合T管引流治疗,对比两组患者的手术过程指标、手术前后血清炎症因子、肝功能指标、电解质水平的变化,手术并发症的发生率差异等。结果: 两组患者的手术过程指标、术后恢复情况分别进行对比分析,A组患者的手术时间短于B组且差异具有显著性(P<0.05);统计分析两组患者的手术出血量、术后首次肛门排气时间、住院时间,结果A组与B组之间无明显的统计学差异性(P>0.05);A组和B组患者的IL-1β、TNF-α组间效应、时间效应、交互效应均具有统计学意义(P<0.05),A组和B组患者的CRP时间效应具有统计学意义(P<0.05);进一步对两组的IL-1β、TNF-α进行两两比较,两组患者各项炎症指标进行组间比较,术后24h A组和B组患者的IL-1β、TNF-α水平对比,指标之间的差异无显著性(P>0.05);术后48h,A组患者的IL-1β、TNF-α测定值低于B组且两组之间差异有统计学意义(P<0.05);A组和B组患者的ALT、TBIL、AST组间效应、交互效应均无统计学意义(P>0.05),A组和B组患者的ALT、TBIL、AST时间效应具有统计学意义(P<0.05);A组和B组患者的Na⁺、K⁺组间效应、交互效应均无统计学意义(P>0.05),A组和B组患者的Na⁺、K⁺时间效应具有统计学意义(P<0.05);A组的并发症率为3.39%,B组患者的并发症率为8.47%,两组患者差异无统计学意义(P>0.05)。结论: LC手术+胆总管切开取石术联合一期缝合与LC手术+胆总管切开取石术联合T管引流治疗胆囊结石、胆总管结石伴急性胆管炎患者的效果差异不大,但是前者具有手术时间更短,术后炎症反应程度更低的优势。

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	李春林
	卢建利

关键词 ：腹腔镜胆囊切除, 胆总管切开取石术, 一期缝合, T管引流, 急性胆管炎

Abstract：Objective: To explore the differences in the effectiveness of laparoscopic cholecystectomy (LC) combined with choledochotomy for stone extraction with one-stage closure and LC combined with choledochotomy for stone extraction with T-tube drainage in the treatment of patients with cholecystolithiasis and choledocholithiasis complicated by acute cholangitis. Methods: A total of 118 patients with gallbladder stones,common bile duct stones, and acute cholangitis diagnosed and requiring surgery at our hospital from January 2020 to December 2022 were selected as the research subjects. Randomized clinical trials were conducted to divide the patients into Group A and Group B, with 59 patients in each group. Group A received LC combined with choledochotomy for stone extraction with one-stage closure, while Group B received LC combined with choledochotomy for stone extraction with T-tube drainage. Surgical process indicators, changes in serum inflammatory factors, liver function indicators, electrolyte levels before and after surgery, and the incidence of surgical complications were compared between the two groups. Results: The operative process indicators and postoperative recovery of patients in the two groups were compared. The operative time in Group A was shorter than in Group B, and the difference was statistically significant (P<0.05). Statistical analysis of intraoperative blood loss, time to first anal exhaust after surgery, and length of hospital stay showed no significant differences between Group A and Group B (P>0.05). The inter-group effects, time effects, and interaction effects of IL-1β and TNF-α in patients of both groups were statistically significant (P<0.05). The time effect of CRP in both groups also showed statistical significance (P<0.05). Further pairwise comparisons of IL-1β and TNF-α between the two groups and inter-group comparisons of various inflammatory indicators revealed no significant differences in the levels of IL-1β and TNF-α between Group A and Group B 24 hours postoperatively (P>0.05). However, 48 hours postoperatively, the levels of IL-1β and TNF-α in Group A were lower than in Group B, and the difference between the two groups was statistically significant (P<0.05). The inter-group effects and interaction effects of ALT, TBIL, and AST in patients of both groups showed no statistical significance (P>0.05). However, the time effects of ALT, TBIL, and AST were statistically significant (P<0.05). The inter-group effects and interaction effects of Na⁺ and K⁺ in patients of both groups showed no statistical significance (P>0.05), but the time effects of Na⁺ and K⁺ were statistically significant (P<0.05). The complication rate in Group A was 3.39%, and in Group B, it was 8.47%, with no statistically significant difference between the two groups (P>0.05). Conclusion: The efficacy difference between LC combined with choledochotomy for stone extraction with one-stage closure and LC combined with choledochotomy for stone extraction with T-tube drainage in patients with cholecystolithiasis and choledocholithiasis complicated by acute cholangitis is not significant. However, the former has the advantage of shorter operative time and lower postoperative inflammatory response.

Key words： Laparoscopic cholecystectomy Choledocholithotomy Primary suture T-tube drainage Acute cholangitis

基金资助:四川省卫生健康委员会科研项目,(编号:20PJ185)

引用本文:

李春林, 卢建利. LC联合腹腔镜下胆总管切开取石术治疗胆总管结石伴急性胆管炎合并胆囊结石的临床疗效观察[J]. 河北医学, 2023, 29(12): 2044-2049.
LI Chunlin, et al. Clinical Efficacy Comparison of Laparoscopic Cholecystectomy Combined with Choledochotomy for Stone Extraction with One-Stage Closure versus T-Tube Drainage in Patients with Choledocholithiasis Complicated by Acute Cholangitis. HeBei Med, 2023, 29(12): 2044-2049.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.12.020 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I12/2044

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