河北医学2023，Vol.29Issue(12)：2044-2049,6.DOI:10.3969/j.issn.1006-6233.2023.12.020
LC联合腹腔镜下胆总管切开取石术治疗胆总管结石伴急性胆管炎合并胆囊结石的临床疗效观察
Clinical Efficacy Comparison of Laparoscopic Cholecystectomy Combined with Choledochotomy for Stone Extraction with One-Stage Closure versus T-Tube Drainage in Patients with Choledocholithiasis Complicated by Acute Cholangitis
摘要
Abstract
Objective:To explore the differences in the effectiveness of laparoscopic cholecystectomy(LC)combined with choledochotomy for stone extraction with one-stage closure and LC combined with chole-dochotomy for stone extraction with T-tube drainage in the treatment of patients with cholecystolithiasis and choledocholithiasis complicated by acute cholangitis.Methods:A total of 118 patients with gallbladder stones,common bile duct stones,and acute cholangitis diagnosed and requiring surgery at our hospital from January 2020 to December 2022 were selected as the research subjects.Randomized clinical trials were con-ducted to divide the patients into Group A and Group B,with 59 patients in each group.Group A received LC combined with choledochotomy for stone extraction with one-stage closure,while Group B received LC com-bined with choledochotomy for stone extraction with T-tube drainage.Surgical process indicators,changes in serum inflammatory factors,liver function indicators,electrolyte levels before and after surgery,and the inci-dence of surgical complications were compared between the two groups.Results:The operative process indica-tors and postoperative recovery of patients in the two groups were compared.The operative time in Group A was shorter than in Group B,and the difference was statistically significant(P<0.05).Statistical analysis of intraoperative blood loss,time to first anal exhaust after surgery,and length of hospital stay showed no signifi-cant differences between Group A and Group B(P>0.05).The inter-group effects,time effects,and inter-action effects of IL-1β and TNF-α in patients of both groups were statistically significant(P<0.05).The time effect of CRP in both groups also showed statistical significance(P<0.05).Further pairwise comparisons of IL-1β and TNF-α between the two groups and inter-group comparisons of various inflammatory indicators revealed no significant differences in the levels of IL-1β and TNF-α between Group A and Group B 24 hours postoperatively(P>0.05).However,48 hours postoperatively,the levels of IL-1β and TNF-α in Group A were lower than in Group B,and the difference between the two groups was statistically significant(P<0.05).The inter-group effects and interaction effects of ALT,TBIL,and AST in patients of both groups showed no statistical significance(P>0.05).However,the time effects of ALT,TBIL,and AST were statistically significant(P<0.05).The inter-group effects and interaction effects of Na+ and K+ in patients of both groups showed no statistical significance(P>0.05),but the time effects of Na+ and K+ were statistically significant(P<0.05).The complication rate in Group A was 3.39%,and in Group B,it was 8.47%,with no statisti-cally significant difference between the two groups(P>0.05).Conclusion:The efficacy difference between LC combined with choledochotomy for stone extraction with one-stage closure and LC combined with choledo-chotomy for stone extraction with T-tube drainage in patients with cholecystolithiasis and choledocholithiasis complicated by acute cholangitis is not significant.However,the former has the advantage of shorter operative time and lower postoperative inflammatory response.关键词
腹腔镜胆囊切除/胆总管切开取石术/一期缝合/T管引流/急性胆管炎Key words
Laparoscopic cholecystectomy/Choledocholithotomy/Primary suture/T-tube drainage/Acute cholangitis引用本文复制引用
李春林,卢建利..LC联合腹腔镜下胆总管切开取石术治疗胆总管结石伴急性胆管炎合并胆囊结石的临床疗效观察[J].河北医学,2023,29(12):2044-2049,6.基金项目
四川省卫生健康委员会科研项目,(编号:20PJ185) （编号:20PJ185）
