双镜联合治疗胆囊结石合并继发性胆总管结石高龄患者的可行性研究

Feasibility study of double endoscopy in treatment of elderly patients with cholecystolithiasis and secondary calculus of common bile duct

摘要:

目的 分析腹腔镜胆囊切除术（LC）联合内镜逆行胰胆管造影术（ERCP）和内镜下乳头括约肌切开术（EST）治疗胆囊结石合并继发性胆总管结石高龄患者的可行性。方法 选取2017年10月－2022年9月该院收治的胆囊结石合并继发性胆总管结石高龄患者78例，均采用LC联合ERCP和EST进行治疗。39例年龄≥80岁的胆囊结石合并继发性胆总管结石患者为高龄组，39例年龄 < 80岁的胆囊结石合并继发性胆总管结石患者为非高龄组。比较两组患者术后3个月结石清除率、手术情况、术后不同时间点疼痛程度［视觉模拟评分法（VAS）］、肝功能指标［总胆红素（TBIL）、碱性磷酸酶（ALP）、谷丙转氨酶（GPT）和直接胆红素（DBIL）］、炎症指标［C反应蛋白（CRP）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）和白细胞（WBC）］和并发症发生率。结果 高龄组结石清除率为97.44%，与非高龄组的100.00%比较，差异无统计学意义（P > 0.05）；高龄组手术相关指标和术后不同时点VAS与非高龄组比较，差异均无统计学意义（P > 0.05）；术后3 d，两组患者TBIL、GPT、ALP和DBIL较术前降低，差异均有统计学意义（P < 0.05），但组间比较，差异均无统计学意义（P > 0.05）；术后1 d，两组患者CRP、IL-10、WBC和TNF-α较术前升高，术后3 d，CRP、IL-10、WBC和TNF-α低于术后1 d，差异均有统计学意义（P < 0.05）；术后1和3 d，两组间CRP、IL-10、WBC和TNF-α比较，差异均无统计学意义（P > 0.05）；高龄组并发症发生率为10.26%（4/39），与非高龄组的5.13%（2/39）比较，差异无统计学意义（P > 0.05）。结论 LC联合ERCP和EST治疗≥80岁的胆囊结石合并继发性胆总管结石患者，结石清除效果确切，并发症发生率低，且不会损伤肝功能，炎症反应轻微，是安全有效的治疗方式。

Abstract:

Objective To analyze the feasibility of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) in treatment of cholecystolithiasis complicated with secondary calculus of common bile duct in advanced ages.Methods Seventy-eight elderly patients with cholecystolithiasis complicated with secondary calculus of common bile duct from October 2017 to September 2022 were selected. All the patients were treated with LC combined with ERCP and EST. 39 patients with cholecystolithiasis and secondary calculus of common bile duct aged ≥ 80 years (elderly group) and 39 patients with cholecystolithiasis and secondary calculus of common bile duct aged < 80 years (non elderly group) in our hospital were selected. At 3 months after operation of the stone clearance rate, operation condition, postoperative pain degree [visual analogue scale (VAS)], liver function indexes [total bilirubin (TBIL), alkaline phosphatase (ALP), glutamic-pyruvic transaminase (GPT) and direct bilirubin (DBIL)], inflammatory indexes [C-reactive protein (CRP), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and white blood cell (WBC)] and complications were compared between the two groups.Results 97.44% stone removal rate in the elderly group compared with 100.00% in the non elderly group, the difference was not statistically significant (P > 0.05); The operative related index, and visual analogue scale (VAS) at different time points after surgery in the elderly group compared with the non elderly group, the differences were not statistically significant (P > 0.05); TBIL, GPT, ALP, and DBIL were lower in both groups 3 d after surgery compared with those before surgery (P < 0.05), and the differences were not statistically significant when compared between the two groups (P > 0.05). CRP, IL-10, WBC, and TNF-α were higher in both groups at 1 d postoperatively than before surgery, and CRP, IL-10, WBC, and TNF-α were lower at 3 d postoperatively than at 1 d postoperatively (P < 0.05); The differences were not statistically significant when comparing CRP, IL-10, WBC, and TNF-α between the two groups at 1 d and 3 d postoperatively (P > 0.05); The incidence of complications was 10.26% (4/39) in the elderly group, compared with 5.13% (2/39) in the non elderly group, the difference was not statistically significant (P > 0.05).Conclusion LC combined with ERCP and EST are effective and safe treatments for patients ≥ 80 years old with cholecystolithiasis complicated with secondary calculus of common bile ducts with exact stone removal, low complication rate, and no increase in liver function damage and inflammatory response.