LC+LCBDE+PDC在胆总管结石合并胆囊结石患者中的应用价值探讨

doi:10.3969/j.issn.2095-378X.2023.01.002

外科研究与新技术 ›› 2023, Vol. 12 ›› Issue (1): 6-9.doi: 10.3969/j.issn.2095-378X.2023.01.002

LC+LCBDE+PDC在胆总管结石合并胆囊结石患者中的应用价值探讨

甄茂川, 周剑寅, 苏永杰, 黎蕴通, 刘平果

厦门大学附属中山医院肝胆胰外科,福建厦门 361000

收稿日期:2022-09-07 发布日期:2023-05-26
作者简介:甄茂川（1973—）,男,博士,副主任医师,从事临床肝胆胰外科工作;电子信箱：zhenmc@sohu.com

Application value of LC+LCBDE+PDC in patients with choledocholithiasis and cholecystolithiasis

ZHEN Maochuan, ZHOU Jianyin, SU Yongjie, LI Yuntong, LIU Pingguo

Department of Hepatobiliary and Pancreatic Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361000, Fujian, China

Received:2022-09-07 Published:2023-05-26

摘要/Abstract

摘要： 目的探讨腹腔镜胆囊切除+胆总管切开取石+胆管一期缝合术（LC+LCBDE+PDC）在胆总管结石合并胆囊结石患者中的应用价值。方法选取2020年6月—2022年6月分别接受腹腔镜胆囊切除+胆总管切开取石+胆管一期缝合术（LC+LCBDE+PDC）治疗的51例胆总管结石合并胆囊结石患者作为LCBDE组,同期选取接受内镜逆行性胰胆管造影（ERCP）+ LC治疗的29例胆总管结石合并胆囊结石患者作为ERCP组;对两组患者临床资料进行回顾性分析。结果 LCBDE组手术时间、住院时间、结石清除率均显著优于ERCP组（P<0.05）,两组术后肛门排气时间比较差异不显著（P>0.05）;治疗前两组焦虑自评量表（SAS）、抑郁自评量表（SDS）、SF-36评分比较差异不显著（P>0.05）,治疗后两组SAS、SDS、SF-36评分均得到显著改善（P<0.05）,且术后LCBDE组SAS、SDS、SF-36评分均显著优于ERCP组（P<0.05）;LCBDE组并发症发生率显著低于ERCP组（P<0.05）。结论与ERCP+LC相比,LC+LCBDE+PDC用于治疗胆总管结石合并胆囊结石有效性和安全性均更高,且能更好地改善患者负面情况和生活质量,值得临床借鉴推广。

关键词: 胆总管结石, 胆囊结石, 腹腔镜胆囊切除术, 内镜逆行性胰胆管造影, 腹腔镜胆总管切开取石术, 胆管一期缝合术

Abstract: Objective To investigate the application value of laparoscopic cholecystectomy+ laparoscopic common bile duct exploration + primary duct closure (LC+LCBDE+PDC) in patients with choledocholithiasis and cholecystolithiasis. Methods From June 2020 to June 2022, 51 patients with choledocholithiasis combined with cholecystolithiasis who underwent LC+LCBDE+PDC in our hospital were selected as LCBDE group. At the same time, 29 patients with choledocholithiasis combined with cholecystolithiasis treated with endoscopic retrograde cholangiopancreatography (ERCP)+ LC were selected as ERCP group. The clinical data of the two groups were retrospectively analyzed. Results The operation time, hospital stay, and stone clearance rate in the LCBDE group were significantly better than those in the ERCP group (P<0.05), and there was no significant difference in the postoperative anal exhaust time between the two groups (P>0.05). The scores of Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and SF-36 were not different between the two groups before treatment (P>0.05), but were all improved after treatment (P<0.05), and the scores in the LCBDE group were significantly better than those in the ERCP group (P<0.05). The incidence of complications in the LCBDE group was significantly lower than that in the ERCP group (P<0.05). Conclusion Compared with ERCP+LC, LC+LCBDE+PDC has higher efficacy and safety in patients with choledocholithiasis combined with gallbladder stones, and can better improve the negative conditions and quality of life in patients, which is worthy of clinical reference and promotion.

Key words: Choledocholithiasis, Cholecystolithiasis, Laparoscopic cholecystectomy, Endoscopic retrograde cholangiopancreatography, Laparoscopic common bile duct exploration, Primary duct closure

中图分类号:

R657.4

甄茂川, 周剑寅, 苏永杰, 黎蕴通, 刘平果. LC+LCBDE+PDC在胆总管结石合并胆囊结石患者中的应用价值探讨[J]. 外科研究与新技术, 2023, 12(1): 6-9.

ZHEN Maochuan, ZHOU Jianyin, SU Yongjie, LI Yuntong, LIU Pingguo. Application value of LC+LCBDE+PDC in patients with choledocholithiasis and cholecystolithiasis[J]. Surgical Research and New Technique, 2023, 12(1): 6-9.

参考文献

[1] 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.
[2] 郭念峰. 心理咨询师(3级)[M]. 北京: 民族出版社, 2005:197.
[3] Loire M, Bridoux V, Mege D, et al.Long-term outcomes of Hartmann's procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI)[J]. Int J Colorectal Dis, 2021, 36(10): 2159-2164.
[4] 杨志凡. 内镜下逆行胰胆管造影联合腹腔镜胆囊切除术与腹腔镜胆囊切除术联合胆总管探查术一期缝合治疗胆囊结石合并胆总管结石的疗效比较[J]. 中国药物与临床, 2021,21(12):2146-2148.
[5] 董建伟, 董亚东, 詹学斌. 腹腔镜联合胆道镜或十二指肠镜同期治疗胆结石合并肝外胆管结石的效果观察[J]. 保健医学研究与实践, 2022, 19(2): 37-39.
[6] Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones [J]. Cochrane Database Syst Rev, 2013, 12(12): CD003327.
[7] 陈曙光. 两镜联合体内冲击波碎石对高龄胆结石合并胆总管结石患者疗效及安全性分析[J].江西医药,2021,56(11):1989-1991.
[8] 程建国, 霞明, 文峰, 等. 内镜逆行胰胆管造影联合腹腔镜胆囊切除术治疗胆囊结石合并胆管结石临床分析[J]. 中华临床医师杂志(电子版), 2011, 5(7): 2110-2112.
[9] Ahn KS, Yong HK, Kang KJ, et al.Impact of preoperative ERCP on laparoscopic cholecystectomy: a case-controlled study with propensity score matching[J]. World J Surg, 2015, 39(9): 2235-2242.
[10] 李涛. 腹腔镜胆囊切除术联合腹腔镜胆总管切开探查术或内镜下逆行胰胆管造影术用于胆囊结石合并胆总管结石效果观察[J]. 中国现代医药杂志, 2021, 23(2): 69-72.
[11] 古广强, 李波, 万祎, 等. 腹腔镜胆囊切除联合术中内镜逆行胰胆管造影治疗老年胆囊结石合并胆总管结石[J]. 中国普通外科杂志, 2018, 27(8): 968-975.

LC+LCBDE+PDC在胆总管结石合并胆囊结石患者中的应用价值探讨

Application value of LC+LCBDE+PDC in patients with choledocholithiasis and cholecystolithiasis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 8

编辑推荐

Metrics

本文评价

[1]	刘南斌, 许艳, 魏玉华, 刘中砚, 陈泉宁, 施宝民. 急性坏疽性胆囊炎39例诊疗分析[J]. 外科研究与新技术, 2021, 10(1): 37-41.
[2]	杨锴, 曾志峰. 腹腔镜下经胆囊管胆总管探查取石术治疗胆囊结石合并胆总管结石的临床疗效观察[J]. 外科研究与新技术, 2020, 9(4): 244-245.
[3]	钟文霞, 龙家棋, 曾建红, 李江梅, 李霜. 右美托咪定在全麻腹腔镜胆囊切除术手术中对炎症因子、血浆D-二聚体、ATⅢ、FDP的影响[J]. 外科研究与新技术, 2020, 9(4): 263-266.
[4]	冯树开, 关丽清, 徐托, 王军, 冯淑娟, 林运年. 腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的疗效分析[J]. 外科研究与新技术, 2017, 6(2): 85-86.
[5]	李正起. 经脐部单孔腹腔镜胆囊切除术的临床观察[J]. 外科研究与新技术, 2016, 5(3): 184-186.
[6]	姚厚山王毅胡志前. 慢性炎症与胆囊癌[J]. 外科研究与新技术, 2014, 3(2): 79-81.
[7]	涂之远，朱勤. 困难腹腔镜胆囊切除术的危险因素和手术技巧[J]. 外科研究与新技术, 2013, 2(2): 87-89.
[8]	曾和平，李桢，刘海龙，叶朕雄，王云峰. 全腹腔镜下双镜联合保胆取石术治疗胆囊结石[J]. 外科研究与新技术, 2013, 2(2): 94-96.