Niu Hong, Liu Fei, Tian Yi-Bo
Department of Gastroenterology, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China.
Department of General Surgery, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China.
World J Clin Cases. 2022 Oct 26;10(30):10931-10938. doi: 10.12998/wjcc.v10.i30.10931.
The incidence of common bile duct (CBD) stones accounts for approximately 10%-15% of all CBD diseases. Approximately 8%-20% of these patients also have gallstones with heterogenous signs and symptoms.
To investigate the clinical effects of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) and LC with CBD excision and stone extraction in one-stage suture (LBEPS) for the treatment of gallbladder and CBD stones.
Ninety-four patients with gallbladder and CBD stones were selected from our hospital from January 2018 to June 2021. They were randomly divided into study and control groups with 47 patients each. The study group underwent LC with ERCP, and the control group underwent LC with LBEPS. Surgery, recovery time of gastrointestinal function, complication rates, liver function indexes, and stress response indexes were measured pre- and postoperatively in both the groups.
The durations of treatment and hospital stay were shorter in the study group than in the control group. There was no significant difference between the one-time stone removal rate between the study and control groups. The time to anal evacuation, resumption of oral feeding, time to bowel sound recovery, and time to defecation were shorter in the study group than in the control group. The preoperative serum direct bilirubin (DBIL), total bilirubin (TBIL), and alanine aminotransferase (ALT) levels were insignificantly higher in the study group than that in the control group. A day after surgery, the postoperative serum DBIL, TBIL, and ALT levels were lower than their preoperative levels in both groups, and of the two groups, the levels were lower in the study group. Although the preoperative serum adrenocorticotrophic (ACTH), cortisol (COR), epinephrine (A), and norepinephrine (NE) levels were higher in the study group than that in the control group, these differences were not significant ( > 0.05). The serum ACTH, COR, A, and NE levels in both groups decreased one day after surgery compared to the preoperative levels, but the inter-group difference was statistically insignificant. Similarly, (91.79 ± 10.44) ng/mL, A, and NE levels were lower in the study group than in the control group. The incidence of complications was lower in the study group than in the control group.
LC combined with ERCP induces only a mild stress response; this procedure can decrease the risk of complications, improve liver function, and achieve and promote a faster recovery of gastrointestinal functions.
胆总管结石的发病率约占所有胆总管疾病的10%-15%。这些患者中约8%-20%还伴有胆囊结石，症状各异。
探讨腹腔镜胆囊切除术（LC）联合内镜逆行胰胆管造影术（ERCP）以及一期缝合胆总管切开取石术（LBEPS）治疗胆囊结石合并胆总管结石的临床效果。
选取2018年1月至2021年6月我院收治的94例胆囊结石合并胆总管结石患者，随机分为研究组和对照组，每组47例。研究组行LC联合ERCP，对照组行LC联合LBEPS。分别于术前及术后测量两组患者的手术情况、胃肠功能恢复时间、并发症发生率、肝功能指标及应激反应指标。
研究组的治疗时间和住院时间均短于对照组。研究组与对照组的一次性结石清除率无显著差异。研究组的肛门排气时间、恢复经口进食时间、肠鸣音恢复时间及排便时间均短于对照组。研究组术前血清直接胆红素（DBIL）、总胆红素（TBIL）及丙氨酸氨基转移酶（ALT）水平略高于对照组，但差异无统计学意义。术后第1天，两组患者的术后血清DBIL、TBIL及ALT水平均低于术前，且研究组低于对照组。虽然研究组术前血清促肾上腺皮质激素（ACTH）、皮质醇（COR）、肾上腺素（A）及去甲肾上腺素（NE）水平高于对照组，但差异无统计学意义（P>0.05）。术后第1天，两组患者血清ACTH、COR及NE水平均较术前下降，但组间差异无统计学意义。同样，研究组的A及NE水平低于对照组，分别为（91.79±10.44）ng/mL。研究组的并发症发生率低于对照组。
LC联合ERCP仅引起轻度应激反应；该术式可降低并发症风险，改善肝功能，并实现和促进胃肠功能更快恢复。
