兰州大学学报（医学版）2025，Vol.51Issue(12)：19-27,9.DOI:10.13885/j.issn.2097-681X.2025.12.003
胆总管结石合并胆囊结石行ERCP术后序贯LC的手术时机研究:一项回顾性研究
Timing of surgical intervention for sequential laparoscopic cho-lecystectomy following endoscopic retrograde cholangiopancre atography in patients with choledocholithiasis and gallbladder stones:a retrospective analysis
摘要
Abstract
Objective To evaluate the clinical efficacy of sequential laparoscopic cholecystectomy(LC)per-formed at various intervals within two weeks following endoscopic retrograde cholangiopancreatography(ER CP)for the management of choledocholithiasis combined with gallbladder stones.Methods The clinical data of 527 patients with choledocholithiasis associated with gallbladder stones,who were admitted to The First Hospital of Lanzhou University for ERCP followed by sequential LC treatment from January 2018 to December 2023,were retrospectively analyzed.The patients were divided into three groups based on the time intervals between ERCP and LC:Group A(≤24 h,n=242),Group B(24～72 h,n=194),and Group C(72 h to 2 weeks,n=91).The general data,preoperative laboratory indices,imaging findings,intraoperative condi-tions,and postoperative outcomes were compared across the three groups,and both univariate and multi-variate Logistic regression analyses were conducted.Influence factors associated with performing LC between 72 h and 2 weeks after ERCP were also evaluated.Results In a cohort of 527 patients,257 were male and 270 female.When compared to Group A and B,Group C demonstrated a significantly higher hospitalization duration(P<0.001),hospitalization cost(P<0.001),overall complication rate post-ERCP(P=0.001)and incidence of post-ERCP cholecystitis(P<0.001);when compared to Group B,Group A exhibited a shorter hospital stay(P<0.05).The results of multifactorial Logistic regression analysis revealed that preoperative total bilirubin levels exceeding three times the upper limit of normal(OR=1.801,95%CI:[1.033,3.139],P=0.038),post-ERCP pancreatitis(OR=3.024,95%CI:[1.188,7.694],P=0.020),and post-ERCP hemorrhage(OR=9.643,95%CI:[1.508,61.664],P=0.017)were identified as independent influencing factors for LC performed 72 h to 2 weeks post-ERCP.Conclusion LC performed within 72 h after ERCP for choledocholi-thiasis combined with gallbladder stones is associated with a shorter postoperative hospital stay and reduced hospitalization costs.For centers capable of performing this procedure,it is recommended that LC be per-formed within 24 h,which can shorten the overall hospital stay and mitigate gallbladder inflammation.For patients with preoperative total bilirubin greater than three times the upper limit of normal,post-ERCP pancreatitis and post-ERCP bleeding,it is advisable to delay the implementation of LC.关键词
内镜逆行胰胆管造影术/腹腔镜胆囊切除术/胆囊结石/胆总管结石/手术时机Key words
endoscopic retrograde cholangiopancreatography/laparoscopic cholecystectomy/gallbladder stone/common bile duct stone/timing of surgery分类
医药卫生引用本文复制引用
仲富鹏,孟文勃,李汛,岳平,王子圆,闫洁熙,王海平,王芳昭,朱克祥,朱晓亮,张磊..胆总管结石合并胆囊结石行ERCP术后序贯LC的手术时机研究:一项回顾性研究[J].兰州大学学报（医学版）,2025,51(12):19-27,9.基金项目
甘肃省普通外科临床医学研究中心资助项目(20JR10FA661) （20JR10FA661）
甘肃省自然科学基金资助项目(20JR10RA676) （20JR10RA676）
