对胆囊结石合并胆总管结石的老年患者实施腹腔镜胆囊切除术联合内镜逆行胰胆管造影术的临床疗效

Clinical efficacy observation of laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography in elderly patients with gallbladder stones and common bile duct stones

摘要:

目的 分析胆囊结石合并胆总管结石（CBDS）的老年患者行腹腔镜胆囊切除术（LC）联合内镜逆行胰胆管造影术（ERCP）的临床疗效。方法 选取2019年1月－2021年3月于该院治疗的104例胆囊结石合并CBDS的老年患者作为试验对象，随机纳入对照组和试验组，各52例。对照组行LC联合腹腔镜胆总管探查取石术（LCBDE），试验组行LC联合ERCP。比较两组患者手术情况、术前和术后1 d应激反应和凝血功能指标、术前和术后3 d肝功能水平以及术后并发症发生情况。结果 试验组住院总费用高于对照组（P < 0.05），住院时间短于对照组（P < 0.05），结石残留率低于对照组（0.00%和13.46%，P < 0.05）。术后1 d，两组患者血清去甲肾上腺素（NE）、皮质醇（Cor）、促肾上腺皮质激素（ACTH）水平及血浆纤维蛋白原（FIB）、D-二聚体水平均较术前升高，且试验组低于对照组（P < 0.05）。术后1 d，两组患者凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）均较术前延长，且试验组短于对照组（P < 0.05）。与术前比较，两组患者术后3 d血清谷丙转氨酶（GPT）、γ-谷氨酰转肽酶（GGT）和谷草转氨酶（GOT）水平明显降低，且试验组低于对照组（P < 0.05）。试验组并发症发生率为3.85%，与对照组的13.46%比较，差异无统计学意义（P > 0.05）。结论 对胆囊结石合并CBDS的老年患者实施LC联合ERCP治疗，不仅可以减轻机体应激反应，改善凝血功能及肝功能，促进术后康复，还可提高结石清除效果，安全性高，值得临床推广应用。

Abstract:

Objective To analyze the clinical efficacy of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with gallbladder stones and common bile duct stones (CBDS).Methods The 104 cases of elderly patients with gallbladder stones combined with CBDS were divided into the test group and the control group by random digital table, and with 52 cases in each group. The control group received laparoscopic common bile duct exploration (LCBDE) on the based of LC, the test group received ERCP on the based of LC. The surgery index, stress response index, coagulation function indicator before surgery and 1 d after surgery, liver function before surgery and 3 d after surgery, the incidence of postoperative complications were compared between the two groups.Results The total hospitalization cost of the test group was higher than that of the control group, the hospital stay was shorter than that of the control group, and the stone residue rate was lower than that of the control group (0.00% vs 13.46%, P < 0.05). 1 d after surgery, the serum levels of norepinephrine (NE), cortisol (Cor), and adrenocorticotropic hormone (ACTH), plasma fibrinogen (FIB) and D-dimer in two groups were increased than those before surgery (P < 0.05); but the above indicators of the test group lower than those of control group (P < 0.05). 1 d after surgery, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were prolonged than those before surgery, but the above indicators of the test group were shorter than those of control group (P < 0.05). Compared with before surgery, 3 d after surgery the serum levels of glutamic-pyruvic transaminase (GPT), γ-glutamyl transferase (GGT) and glutamic-oxaloacetic transaminase (GOT) were reduced, and the test group were lower than those of control group (P < 0.05). There was no significant difference in the incidence of complications between the two groups (3.85% vs 13.46%, P > 0.05).Conclusion LC combined with ERCP applied to elderly patients with gallbladder stones and CBDS, could improve stones clearance effect, reduce the body stress response, improve coagulation function and liver function, promote postoperative recovery, and have high security.