腹腔镜术前或术中联合十二指肠镜治疗胆囊结石合并胆总管结石临床疗效分析

发布时间：2018-05-31 17:00

本文选题：胆囊结石 + 胆总管结石　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:通过回顾性分析腹腔镜术前或术中联合十二指肠镜治疗胆囊结石合并胆总管结石的临床疗效,探讨在不同时期使用双镜联合治疗的安全性及可行性,并通过对比术后并发症的发生率以指导临床决策,为合理选择双镜联合治疗胆囊结石合并胆总管结石的方式提供可靠参考和依据。方法:按照纳入标准及排除标准筛选出2015年1月1日至2017年2月28日符合条件的采用双镜联合治疗的胆囊结石合并胆总管结石的患者,按照其行十二指肠镜的时期不同,将其分为术前ERCP/EST/ENBD/EPBD+LC组(Pre-ERCP+LC)和术中ERCP/EST/ENBD/EPBD+LC组(Io-ERCP+LC),两组的手术操作均由熟练掌握腹腔镜及内镜操作诊疗技术的专业人员负责实施,比较两组患者性别组成,年龄,实验室检查,肝功能分级,胆囊结石及胆总管结石直径的大小,胆总管直径等基本临床资料,通过比较两组病例的手术完成情况,手术指标,并发症指标及术后指标来评价其临床疗效,以分析不同阶段应用双镜联合的治疗效果及安全性。结果:两组性别组成,年龄,实验室检查,肝功能分级,胆囊结石及胆总管结石直径大小,胆总管直径等基本临床资料均无统计学差异(P0.05),两组患者临床资料具有可比性。两组患者在手术时间,术中出血,结石清除率,结石残留率上均无统计学差异(P0.05),表明不同时期进行的手术治疗在两组患者其治疗结石的临床疗效都是没有差异的,在术后并发症方面,Pre-ERCP+LC组总并发症发生率24.1%,Io-ERCP+LC组总并发症发生率36.4%,两组患者中均未出现误吸,消化道穿孔,急性胆管炎,胆漏,胆道损伤等严重并发症,但不同程度的PEP及高胰酶血症仍是发生率较高的并发症,且在两组之间没有明显差异(P0.05),但两组患者在整个治疗过程中的NRS疼痛评分,手术费用及住院时间上有明显差异,差异具有统计学意义(P0.05),Io-ERCP+LC组患者疼痛评分较低,住院时间更短,费用花费更少,术后随访1-3个月两组病例均未出现结石复发,胆管炎等并发症。结论:术中及术前十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石这两种不同阶段的手术方式在结石清除方面具有较好的临床疗效并且安全可行,短期随访无结石复发。而术中同期行十二指肠镜联合腹腔镜的治疗方式在保证同样的临床疗效下,能够减少患者因操作产生的不适,使患者在治疗过程中痛苦更少,提高患者耐受手术的能力,还能够缩短住院时间,减少手术费用。
[Abstract]:Objective: to retrospectively analyze the clinical effect of laparoscopic combined duodenoscopy before and during operation on cholecystolithiasis complicated with choledocholithiasis, and to explore the safety and feasibility of using double-mirror combined therapy in different stages of cholecystolithiasis and choledocholithiasis. By comparing the incidence of postoperative complications to guide the clinical decision-making, and to provide a reliable reference and basis for the reasonable selection of double-mirror combined treatment of cholecystolithiasis combined with choledocholithiasis. Methods: according to the inclusion criteria and exclusion criteria, patients with cholecystolithiasis combined with choledocholithiasis were selected from January 1, 2015 to February 28, 2017, according to the period of duodenoscopy. It was divided into preoperative ERCP/EST/ENBD/EPBD LC group (Pre-ERCP LC) and intraoperative ERCP/EST/ENBD/EPBD LC group (Io-ERCP LC). The operation of the two groups was performed by professionals who were skilled in laparoscopy and endoscopic operation. The sex composition, age, and laboratory examination of the two groups were compared. The basic clinical data such as liver function grade, diameter of gallstone and choledocholithiasis, diameter of choledochus, and so on, were compared to evaluate the clinical effect of the two groups by comparing the operation completion, operation index, complication index and postoperative index. To analyze the efficacy and safety of double-mirror combination in different stages. Results: there were no significant differences in sex, age, laboratory examination, liver function grade, diameter of gallstone and common bile duct stone, diameter of common bile duct between the two groups (P 0.05). The clinical data of the two groups were comparable. There was no significant difference in operation time, intraoperative bleeding, stone clearance rate and stone residual rate between the two groups. The total complication rate of pre-ERCP LC group was 24.1% and that of Io-ERCP LC group was 36.4%. There were no serious complications such as aspiration, perforation of digestive tract, acute cholangitis, bile leakage and biliary tract injury in both groups. However, the incidence of PEP and hyperlipidemia was still high, and there was no significant difference between the two groups (P 0.05). However, there were significant differences in NRS pain score, operation cost and hospital stay between the two groups during the whole course of treatment. The difference was statistically significant in the patients with Io-ERCP LC. The pain score was lower, the hospitalization time was shorter, and the cost was lower. There were no complications such as calculi recurrence and cholangitis in the follow-up of 1-3 months after operation. Conclusion: the operative methods of cholecystolithiasis combined with choledocholithiasis at different stages of operation and preoperative duodenoscopy combined with laparoscopy have better clinical efficacy and safety and feasibility in the removal of gallstones, and there is no recurrence of stones in short-term follow-up. Meanwhile, under the same clinical effect, the treatment of duodenoscopy combined with laparoscopy during the same period of operation can reduce the discomfort caused by the operation, reduce the pain and improve the patient's ability to tolerate the operation. It can also shorten the hospital stay and reduce the cost of operation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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