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腹腔镜胆囊切除术联合胆道镜治疗胆囊结石合并胆总管结石的临床疗效

Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis.

作者信息

Liu Chao-Hui, Chen Zhi-Wei, Yu Zhe, Liu Hong-Yu, Pan Jian-Sheng, Qiu Shuang-Shuang

机构信息

Department of General Surgery, The Affiliated Haixia Hospital of Huaqiao University (910 Hospital of Joint Logistic Support Force), Quanzhou 362000, Fujian Province, China.

Department of General Surgery, Anxi Hospital of Traditional Chinese Medicine, Quanzhou 362499, Fujian Province, China.

出版信息

World J Gastrointest Surg. 2024 Jul 27;16(7):2080-2087. doi: 10.4240/wjgs.v16.i7.2080.

DOI:10.4240/wjgs.v16.i7.2080
PMID:39087102
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11287684/
Abstract

BACKGROUND: Currently, endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy (LC) is the main treatment for cholecystolithiasis combined with choledocholithiasis. However, the treatment is unsatisfactory, and the development of better therapies is needed. AIM: To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis. METHODS: Patients ( = 243) with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University (910 Hospital of Joint Logistic Support Force) between January 2019 and December 2023 were included in the study; 111 patients (control group) underwent ERCP + LC and 132 patients (observation group) underwent LC + laparoscopic common bile duct exploration (LCBDE). Surgical success rates, residual stone rates, complications (pancreatitis, hyperamylasemia, biliary tract infection, and bile leakage), surgical indicators [intraoperative blood loss (IBL) and operation time (OT)], recovery indices (postoperative exhaust/defecation time and hospital stay), and serum inflammatory markers [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were compared. RESULTS: No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups. However, the complication rate, IBL, OT, postoperative exhaust/defecation time, and hospital stays were significantly reduced in the observation group compared with the control group. Furthermore, CRP, TNF-α, and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group. CONCLUSION: These results indicate that LC + LCBDE is safer than ERCP + LC for the treatment of cholecystolithiasis combined with choledocholithiasis. The surgical risks and postoperative complications were lower in the observation group compared with the control group. Thus, patients may recover quickly with less inflammation after LCBDE.

摘要

背景：目前，内镜逆行胰胆管造影术（ERCP）联合腹腔镜胆囊切除术（LC）是胆囊结石合并胆总管结石的主要治疗方法。然而，该治疗效果并不理想，需要开发更好的治疗方法。 目的：确定LC联合胆道镜治疗胆囊结石合并胆总管结石的临床疗效。 方法：纳入2019年1月至2023年12月在华侨大学附属海峡医院（联勤保障部队第910医院）收治的胆囊结石合并胆总管结石患者（n = 243）；111例患者（对照组）接受ERCP + LC，132例患者（观察组）接受LC + 腹腔镜胆总管探查术（LCBDE）。比较手术成功率、残余结石率、并发症（胰腺炎、高淀粉酶血症、胆道感染和胆漏）、手术指标[术中出血量（IBL）和手术时间（OT）]、恢复指标（术后排气/排便时间和住院时间）以及血清炎症标志物[C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）]。 结果：观察组和对照组在手术成功率和残余结石率方面未检测到显著差异。然而，与对照组相比，观察组的并发症发生率、IBL、OT、术后排气/排便时间和住院时间显著降低。此外，与对照组相比，观察组治疗后的CRP、TNF-α和IL-6水平降低。 结论：这些结果表明，LC + LCBDE治疗胆囊结石合并胆总管结石比ERCP + LC更安全。与对照组相比，观察组的手术风险和术后并发症更低。因此，LCBDE术后患者炎症反应较轻，恢复较快。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a95d/11287684/283225ae6131/WJGS-16-2080-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a95d/11287684/8e700a9e3a36/WJGS-16-2080-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a95d/11287684/84d105d95f55/WJGS-16-2080-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a95d/11287684/283225ae6131/WJGS-16-2080-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a95d/11287684/8e700a9e3a36/WJGS-16-2080-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a95d/11287684/84d105d95f55/WJGS-16-2080-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a95d/11287684/283225ae6131/WJGS-16-2080-g003.jpg

相似文献

[1]
Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis.

World J Gastrointest Surg. 2024-7-27

[2]
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[3]
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[4]
[Comparison of three surgical patterns for cholecysto-choledocholithiasis].

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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis.

Updates Surg. 2025-4

本文引用的文献

[1]
Reclaiming the management of common duct stones in acute care surgery.

J Trauma Acute Care Surg. 2023-10-1

[2]
Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for patients with gallbladder and common bile duct stones a meta-analysis of randomized controlled trials.

Eur Rev Med Pharmacol Sci. 2023-5

[3]
Upfront Laparoscopic Management of Common Bile Duct Stones: What Are the Risk Factors of Failure?

J Gastrointest Surg. 2023-9

[4]
Current management of concomitant cholelithiasis and common bile duct stones.

World J Gastrointest Surg. 2023-2-27

[5]
Evaluation of the Common bile duct (CBD) Diameter After Laparoscopic Cholecystectomy (LC) and Laparoscopic Common Bile Duct Exploration (LCBDE): A Retrospective Study.

Surg Laparosc Endosc Percutan Tech. 2023-2-1

[6]
Association of Laparoscopic Methods and Clinical Outcomes of Cholecystolithiasis Plus Choledocholithiasis: A Cohort Study.

Turk J Gastroenterol. 2023-1

[7]
Is early laparoscopic cholecystectomy after clearance of common bile duct stones by endoscopic retrograde cholangiopancreatography superior?: A systematic review and meta-analysis of randomized controlled trials.

Medicine (Baltimore). 2022-11-11

[8]
Making common duct exploration common-balloon sphincteroplasty as an adjunct to transcystic laparoscopic common bile duct exploration for pediatric patients.

J Pediatr Surg. 2023-1

[9]
One-stage versus two-stage approach for concomitant gallbladder and common bile duct stones: which one is more proper in patients over 80 years old?

J Minim Invasive Surg. 2022-3-15

[10]
Endoscopic Stone Extraction followed by Laparoscopic Cholecystectomy in Tandem for Concomitant Cholelithiasis and Choledocholithiasis: A Prospective Study.

J Clin Exp Hepatol. 2022

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