三种手术方案治疗胆囊结石并胆总管结石的疗效及对血清GGT ALP的影响

doi:10.3969/j.issn.1006-6233.2019.01.003

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Abstract Objective: To analyze the curative effect of three surgical schemes for cholecystolithiasis with common bile duct stones and their effects on serum alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT). Methods: 115 cases of cholecystolithiasis and choledocholithiasis treated in our hospital from February 2015 to March 2017 were analyzed and divided into 3 groups according to different operative methods, among them, 31 patients were treated with laparoscopic cholecystectomy (LC) combined with choledochoscopy common bile duct exploration (LCBDE), named group A; 45 cases were treated with LC combined with endoscopic retrograde cholangiopancreatography (ERCP), named group B; 39 cases were treated with traditional open cholecystectomy choledochal exploration (CBDE), named group C. The operation index, postoperative complications, and the changes of serum GGT and ALT levels of patients in 3 groups before and after operation, and the effect of operation were observed. Results: The operative time, intraoperative blood loss, postoperative fasting time, postoperative exhaust time and length of stay in group A and group B were significantly lower than those in group C (P<0.05); the intraoperative blood loss and postoperative exhaust time in group A were approximately equal to those in group B (P>0.05). The incidence of complications in group C was significantly higher than that in group A and group B (P<0.05), and the difference between group A and group B was not statistically significant (P>0.05). There was no significant difference in GGT and ALP between the three groups of A, B and C before operation (P>0.05); the levels of GGT and ALP in group A and group B were significantly lower than those in group C (P<0.05), and GGT and ALP levels in group A were significantly lower than those in group B (P<0.05). The success rate of operation in group A and group B was significantly higher than that in group C (P<0.05), and the stones recurrence rate in group A and group B was significantly lower than that in group C (P>0.05); the success rate of operation in group A was significantly higher than that in group B (P>0.05), the stone recurrence rate in group A was significantly lower than that in group B (P>0.05), and group B and group C had one case of residual stones respectively , and recovered after repeated ERCP and choledochoscopy. Conclusion: Compared with traditional open surgery, minimally invasive combined operation has obvious advantages in treating cholecystolithiasis and choledocholithiasis, all the indexes of LC+LCBDE operation are better than that of LC+ERCP, the success rate of operation is high, the incidence rate of postoperative complications, the stones residual rate and the stones recurrence rate are relatively low, which can be considered as the main operation for the treatment of cholecystolithiasis and choledocholithiasis.

Key words： Cholecystolithiasis combined choledocholithiasis Laparoscopic cholecystectomy Laparoscopic common bile duct exploration Alkaline phosphatase γ-glutamyl transpeptidase

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	HAO Yuqing
	JIANG Xuwei
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HAO Yuqing,JIANG Xuwei,et al. Therapeutic Effect of three Surgical Schemes on Cholecystolithiasis with Choledocholithiasis and its Influence on Serum GGT and ALP[J]. HeBei Med, 2019, 25(1): 9-13.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2019.01.003 OR http://www.hbyxzzs.cn/EN/Y2019/V25/I1/9

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