摘要
目的经内镜逆行胰胆管造影术+腹腔镜下胆囊切除术(ERCP+LC)和腹腔镜下胆总管探查术+腹腔镜下胆囊切除术(LCBDE+LC)联合手术治疗老年急性胆囊炎合并胆管炎的疗效和安全性比较。方法收集河南大学第一附属医院在2021年1月至2023年1月期间被诊断为胆囊结石性胆囊炎和胆总管结石性胆管炎的老年患者100例(年龄≥60岁),以随机分组方式进行分组研究。行LCBDE+LC的患者分为A组(n=50),行ERCP+LC的患者分为B组(n=50),比较两组患者疗效和手术安全性。结果两组患者术后胆总管内径、白细胞计数、直接胆红素、谷丙转氨酶等指标均下降(P<0.05),其中B组白细胞计数低于A组(P<0.05);B组患者平均手术时间、总麻醉时间、总住院时间、手术出血量低于A组[(77.52±26.2)min vs.(120.78±25.6)min;(91.22±20.6)min vs.(133.17±25.6)min;(9.89±3.41)d vs.(10.96±1.71)d;(24.72±7.13)mL vs.(59.3±15.58)mL](P<0.05)。A组术后严重并发症发生率[30%(15/50)]高于B组[10%(5/50)](P<0.05)。结论ERCP+LC手术治疗老年性急性胆囊炎合并胆管炎的安全性更高,疗效和LCBDE+LC手术整体相当,在控制感染方面效果更好。
【Objective】To compare the efficacy and safety of endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic cholecystectomy(LC)with laparoscopic common bile duct exploration(LCBDE)and LC in the treatment for elderly patients with acute cholecystitis complicated with cholangitis.【Methods】A total of 100 elderly patients(aged>60 years)diagnosed with gallstone cholecystitis and gallstone cholangitis caused by common bile duct stones at the First Affiliated Hospital of Henan University from January 2021 to January 2023 were collected and randomized for study.Patients undergoing LCBDE+LC were divided into group A(n=50),while patients undergoing ERCP+LC were divided into group B(n=50).The efficacy and surgical safety of the two groups were compared.【Results】After treatment,the inner diameter of the common bile duct,white blood cell count,direct bilirubin,alanine aminotransferase and other indicators in both groups of patients decreased(P<0.05).Among them,the white blood cell count in group B was lower than that in group A(P<0.05).The average surgical time,total anesthesia time and total hospital stay of patients in group B were shorter,and surgical bleeding volume of patients in group B were lower than those in group A(77.52±26.2 min vs.120.78±25.6 min;91.22±20.6 min vs.133.17±25.6 min;9.89±3.41 d vs.10.96±1.71 d;24.72±7.13 mL vs.59.3±15.58 mL)(P<0.05).The incidence of severe postoperative complications in group A was 30%(15/50),higher than that in group B[10%(5/50)](P<0.05).【Conclusion】ERCP+LC surgery is safer and more effective than LCBDE+LC surgery in treating elderly patients with acute cholecystitis complicated with cholangitis.Its overall efficacy is comparable to LCBDE+LC surgery,and it is more effective in controlling infections.
作者
程序
魏书堂
徐菱遥
CHENG Xu;WEI Shutang;XU Lingyao(Department of Gastroenterology,the First Affiliated Hospital of Henan University,Kai Feng,Henan 475000,China)
出处
《中国医学工程》
2025年第5期50-54,共5页
China Medical Engineering
基金
2021年河南省医学科技攻关联合共建项目(LHGJ20210573)。
关键词
胆囊炎
胆管炎
胆结石
引流
经内镜逆行胰胆管造影
腹腔镜下胆总管探查术
cholecystitis
cholangitis
gallstones
drainage
endoscopic retrograde cholangiopancreatography
laparoscopic common bile duct exploration
