| 沙正宏,邱 钧,方 寅,项本宏,张 毅.一步法腹腔镜胆囊切术联合胆总管探查取石术在慢性胆囊炎胆囊结石合并胆总管结石治疗中的有效性及安全性探究[J].,2022,(18):3582-3586 |
| 一步法腹腔镜胆囊切术联合胆总管探查取石术在慢性胆囊炎胆囊结石合并胆总管结石治疗中的有效性及安全性探究 |
| Study on the Effectiveness and Safety of One-step Laparoscopic Cholecystectomy Combined with Laparoscopic Common Bile Duct Exploration in the Treatment of Chronic Cholecystitis with Gallstones Combined with Common Bile Duct Stones |
| 投稿时间：2022-03-06 修订日期：2022-03-30 |
| DOI：10.13241/j.cnki.pmb.2022.18.035 |
| 中文关键词: 一步法 腹腔镜胆囊切术 胆总管探查取石术 慢性胆囊炎胆囊结石合并胆总管结石 有效性 安全性 |
| 英文关键词: One-step method Laparoscopic cholecystectomy Laparoscopic common bile duct exploration Chronic cholecystitis with gallstones combined with common bile duct stones Effectiveness Safety |
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| 中文摘要: |
| 摘要 目的：探究一步法腹腔镜胆囊切术（LC）联合胆总管探查取石术（LCBDE）在慢性胆囊炎胆囊结石合并胆总管结石治疗中的有效性及安全性。方法：纳入2018年6月至2021年9月行一步法LC+LCBDE治疗的慢性胆囊炎胆囊结石合并胆总管结石患者49例（观察组），并以行开腹胆囊切除术+胆总管切开取石治疗的慢性胆囊炎胆囊结石合并胆总管结石患者43例为对照组，比较两组手术疗效及手术相关指标；观察患者手术前后肝功能指标、胆红素水平及免疫功能变化，并统计患者术后并发症发生情况。结果：观察组及对照组手术成功率均为100%，两组对比无明显差异（P>0.05）；观察组手术时间、肠鸣音恢复时间、肛门恢复排气时间及住院时间短于对照组，术中出血量少于对照组（P<0.05）；观察组术后丙氨酸氨基转移酶（ALT）、γ-谷氨酰转肽酶（GGT）、天冬氨酸氨基转移酶（AST）及总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）水平均低于对照组（P<0.05）；观察组术后7 d的免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）水平均高于对照组（P<0.05）；观察组术后并发症发生率低于对照组（P<0.05）。结论：一步法LC+LCBDE治疗慢性胆囊炎胆囊结石合并胆总管结石的成功率高，可促进术后胃肠功能及肝功能恢复，提高机体免疫力，并能降低术后并发症发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effectiveness and safety of one-step laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of chronic cholecystitis with gallstones combined with common bile duct stones. Methods: A total of 49 patients with chronic cholecystitis with gallstones combined with common bile duct stones undergoing one-step LC and LCBDE were enrolled as observation group between June 2018 and September 2021, while other 43 patients with chronic cholecystitis and gallbladder stones undergoing open cholecystectomy were enrolled as control group. The surgical efficacy and related indexes between the two groups were compared. The changes of liver function indexes, bilirubin and immune function before and after surgery were observed. The occurrence of postoperative complications was statistically analyzed. Results: The difference in surgical success rate between observation group and control group was not statistically significant (100% vs 100%) (P>0.05). The operation time, recovery time of bowel sounds and anal exhaust, and hospitalization time in observation group were shorter than those in control group, and intraoperative blood loss was less than that in control group (P<0.05). After surgery, levels of alanine aminotransferase (ALT), glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) in observation group were lower than those in control group (P<0.05), levels of immunoglobulin A (IgA), immunoglobulin G (IgG) and immunoglobulin M (IgM) were higher than those in control group at 7 d after surgery (P<0.05), and incidence of postoperative complications was lower than that in control group (P<0.05). Conclusion: The one-step LC+LCBDE has high success rate in the treatment of chronic cholecystitis with gallstones combined with common bile duct stones, which can promote postoperative recovery of gastrointestinal function and liver function, enhance immunity and reduce the incidence of postoperative complications. |
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