徐志鹏 张道建 郭久冰

【摘要】 目的：探讨经内镜逆行胰胆管造影（ERCP）联合腹腔镜胆囊切除术（LC）治疗胆囊结石合并胆总管结石的效果。方法：选取2015年9月-2018年8月笔者所在医院收治的106例胆囊结石合并胆总管结石患者，按随机数字表法分为A组（53例）和B组（53例），A组采取传统开腹手术，B组采取ERCP联合LC治疗，比较临床疗效。结果：B组肠鸣音恢复时间、肛门排气时间、住院时间均短于A组，术中出血量、术后并发症发生率均低于A组，差异均有统计学意义（P<0.05）;两组手术时间比较差异无统计学意义（P>0.05）;两组治疗后COR、NE和A水平均明显高于治疗前，但B组COR、NE和A水平均明显低于A组，差异均有统计学意义（P<0.05）。结论：与传统开腹手术相比，ERCP联合LC治疗胆囊结石合并胆总管结石具有微创、应激反应轻、术后并发症少及术后康复快等优点，值得在临床应用。

【关键词】 腹腔镜胆囊切除术 经内镜逆行胰胆管造影 胆囊结石 胆总管结石 开腹手术 临床疗效

doi：10.14033/j.cnki.cfmr.2019.30.062 文献标识码 B 文章编号 1674-6805（2019）30-0-03

[Abstract] Objective： To evaluate the efficacy of endoscopic retrograde cholangiopancreatography （ERCP） combined with laparoscopic cholecystectomy （LC） in the treatment of gallstones complicated with common bile duct stones. Method： A total of 106 patients with gallstones complicated with common bile duct stones admitted to our hospital from September 2015 to August 2018 were randomly divided into group A （53 cases） and group B （53 cases）. Group A adopted traditional Open surgery， group B was treated with ERCP combined with LC， and the clinical efficacy of different groups was compared. Result： The recovery time of intestinal sound， anal exsufflation time and hospitalization time in group B were shorter than those in group A， and the amount of bleeding during operation and the incidence of postoperative complications in group B were significantly lower than those in group A （P<0.05）. There was no significant difference in operation time between the two groups （P>0.05）. After treatment， the levels of COR， NE and A in group B were significantly higher than those before treatment， but the levels of COR， NE and A in group B were significantly lower than those in group A （P<0.05）. Conclusion： Compared with traditional open surgery， ERCP combined with LC for the treatment of gallbladder stones with common bile duct stones has the advantages of minimally invasive， light stress response， less postoperative complications and quick postoperative recovery. It is worthy of clinical application.

[Key words] Laparoscopic cholecystectomy Endoscopic retrograde cholangiopancreatography Gallstones Common bile duct stones Open surgery Clinical efficacy

First-authors address： Xiamen Haicang Hospital， Xiamen 361026， China

膽总管结石包括原发性和继发性胆总管结石，多数患者为后者，主要因胆囊内或肝管内结石移行到胆总管所引起[1]。胆囊结石合并胆总管结石多存在高热、寒战、腹痛和黄疸等症状，需通过取出结石和解除梗阻来消除症状，否则将引起胆源性胰腺炎、肝损伤及全身感染，病情严重者可能致死[2]。手术治疗仍然是目前临床治疗胆囊结石合并胆总管结石的主要手段，但传统开腹手术具有创伤大、并发症多和术后康复慢等不足，不易于患者所接受[3]。随着医疗微创手术的迅猛发展，微创手术被广泛用于胆囊结石疾病;经内镜逆行胰胆管造影（ERCP）联合腹腔镜胆囊切除术（LC）在治疗胆囊结石方面因具有创伤小、术后恢复快及安全性高等微创理念，受到广大临床学者及患者欢迎[4]。……