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中华普外科手术学杂志(电子版) ›› 2025, Vol. 19 ›› Issue (01) : 60 -63. doi: 10.3877/cma.j.issn.1674-3946.2025.01.017.

论著

ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果
李博1, 贾蓬勃1, 李栋1, 李小庆1,()   
  1. 1.712000 陕西咸阳,咸阳市第一人民医院肝胆胰脾外科
  • 收稿日期:2023-06-05 出版日期:2024-12-25
  • 通信作者: 李小庆
  • 基金资助:
    陕西省自然科学基础研究计划项目(2021JM-591)

Effect of ERCP and LCBDE on acute severe cholangitis secondary to choledocholithiasis

Bo Li1, Pengbo Jia1, Dong Li1, Xiaoqing Li1,()   

  1. 1.Department of Hepatobiliary,Pancreatic and Spleen,the First People's Hospital,Xianyang Shaanxi Province 712000,China
  • Received:2023-06-05 Published:2024-12-25
  • Corresponding author: Xiaoqing Li
引用本文:

李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.

Bo Li, Pengbo Jia, Dong Li, Xiaoqing Li. Effect of ERCP and LCBDE on acute severe cholangitis secondary to choledocholithiasis[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 60-63.

目的

探究经内镜逆行胰胆管造影术(ERCP)与腹腔镜下胆总管探查取石术(LCBDE)治疗胆总管结石继发急性重症胆管炎(ACST)的效果。

方法

回顾性分析2022年1月至2024年1月行手术治疗的120例胆总管结石继发ACST患者的临床资料,依据手术方式不同将行ERCP治疗的患者设为ERCP组(n=68例),行LCBDE治疗的患者设为LCBDE组(n=52例)。采用SPSS 26.0进行数据处理,围手术期各项指标等计量资料以(x± s)表示,行独立样本t检验;并发症发生情况等计数资料行χ2检验;检验水准α=0.05。

结果

ERCP组患者术中出血量较LCBDE组低,手术时间、活动恢复时间、首次排气时间及住院时间均较LCBDE组短(P<0.05);ERCP组与LCBDE组结石取净率(98.5% vs.96.2%)比较,差异无统计学意义(P>0.05);术后ERCP组与LCBDE组患者肝胆生化指标血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)均较术前低(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组患者炎症指标白细胞计数(WBC)、中性粒细胞计数(ANC)、血清高迁移率族蛋白B1(HMGB1)均较术前降低(P<0.05),且ERCP组明显较LCBDE组低(P<0.05);术后ERCP组患者并发症总发生率较LCBDE组低(1.5% vs.11.5%,P<0.05)。

结论

与LCBDE相较,ERCP治疗胆总管结石继发ACST效果更佳。该术式可明显改善患者手术与术后恢复指标,促进肝胆及炎症快速恢复,且并发症风险小,可作为临床首选治疗胆总管结石继发ACST的手段。

Objective

To explore the efficacy of endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic choledocholithotomy (LCBDE) in the treatment of acute severe cholangitis (ACST)secondary to choledocholithiasis.

Methods

The clinical data of one hundred and twenty patients with ACST secondary to CBDS who received surgical treatment were retrospectively analyzed from January 2022 to January 2024.AccorThe clinical data of 120 patients with ACST secondary to choledocholithiasis who underwent surgical treatment from January 2022 to January 2024 were retrospectively analyzed.According to different surgical methods, patients receiving ERCP treatment were assigned to the ERCP group (n=68 cases) and those receiving LCBDE treatment were assigned to the LCBDE group (n=52 cases).SPSS 26.0 was used for data processing.Measurement data such as perioperative indicators were expressed as (x± s), and independent sample t test was performed.The incidence of complications and other statistical data were χ2 test.Test level α=0.05.

Results

The amount of intraoperative blood loss in ERCP group was lower than that in LCBDE group, and the operation time, activity recovery time, first exhaust time and hospital stay were shorter than that in LCBDE group(P<0.05).There was no significant difference in stone removal rate between ERCP group and LCBDE group(98.5% vs.96.2%, P>0.05).The liver and bile biochemical indexes of serum total bilirubin (TBIL), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in ERCP group and LCBDE group were lower than those before surgery (P<0.05), but there was no statistical significance between the two groups (P>0.05).The inflammatory markers of white blood cell count (WBC), neutrophil count (ANC) and serum high mobility group protein B1 (HMGB1) in 2 groups were lower than those before surgery (P<0.05), and ERCP group was significantly lower than LCBDE group (P<0.05).The overall complication rate in the ERCP group was lower than that in the LCBDE group (1.5% vs.11.5%) (P<0.05).

Conclusion

ERCP is more effective than LCBDE in the treatment of ACST secondary to choledocholithiasis.This procedure can significantly improve the surgical and postoperative recovery indicators of patients, promote the rapid recovery of liver and gallbladder and inflammation, and the risk of complications is small, so it can be used as the first choice in clinical treatment of ACST secondary to choledocholithiasis.

表1 两组患者基线资料比较
表2 两组患者围手术期指标比较(x± s
表3 两组患者手术前后肝胆生化指标比较(x± s
表4 两组患者手术前后炎症指标比较(x± s
表5 两组患者术后并发症发生情况比较[例(%)]
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