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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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

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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[J]. HeBei Med, 2023, 29(12): 2044-2049.

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

[1] 张男男,吴钢,周远航,等.加速康复外科在老年患者行腹腔镜胆囊切除术联合胆总管切开探查取石术中的应用[J].肝胆胰外科杂志,2021,33(7):396-400,406.
[2] 詹志林,包长军,唐慧鹏,等.免支架腹腔镜胆囊切除+胆总管切开取石术一期缝合临床经验及技术改进65例分析[J].山西医药杂志,2022,51(15):1737-1739.
[3] 魏耕富,马智,权力,等.腹腔镜胆囊切除术、胆总管切开取石术联合胆总管一期缝合术治疗胆管结石的临床效果[J].临床误诊误治,2020,33(6):52-56.
[4] 中华医学会外科学分会胆道外科学组.肝胆管结石病诊断治疗指南[J].中华消化外科杂志,2007,6(2):156-161.
[5] Mohammed AO,Alaa AR,Marwa NA.Comparative study of three common bile duct closure techniques after choledocholithotomy:safety and efficacy[J].Langenbeck's archives of surgery,2022,407(5):1805-1815.
[6] 顾越雷,郭德凯,李镇伽,等.腹腔镜胆总管切开探查取石+腹腔镜胆囊切除术与经内镜逆行胰胆管造影/内镜下括约肌切开取石+腹腔镜胆囊切除术治疗结石性急性梗阻性化脓性胆管炎的疗效比较[J].临床外科杂志,2021,29(7):622-625.
[7] 刘振华.腹腔镜胆囊切除术+腹腔镜胆总管切开取石(一期缝合)[J].中华肝脏外科手术学电子杂志,2021,10(2):228.
[8] 任秀华,杨艳英,曾新桃,等.腹腔镜胆囊切除术前患者血清IL-1β、IL-6、TNF-α水平与瑞芬太尼所致痛觉过敏的相关性[J].中国现代医学杂志,2022,32(11):85-90.
[9] 宁小晶,殷毅,李鹏,等.血清炎症因子及应激指标与做腹腔镜胆囊切除术患者近期并发症发生的相关性研究[J].中国临床医生杂志,2022,50(3):330-332.
[10] 韩卓兴,林晖,段世刚,等.SpyGlassDS系统联合内镜逆行胰胆管造影术对胆总管结石患者的治疗作用[J].山东大学学报(医学版),2023,61(9):94-100.