单孔加一孔LCBDE一期缝合联合LC治疗胆囊结石合并胆总管结石的效果分析OA
Efficacy of single-incision plus one-port LCBDE with primary suture combined with LC for cholecystolithiasis complicated by choledocholithiasis
目的 分析单孔加一孔腹腔镜胆总管探查(LCBDE)一期缝合联合腹腔镜胆囊切除术(LC)对比内镜逆行胰胆管造影(ERCP)序贯三孔LC对胆囊结石合并胆总管结石的疗效.方法 回顾性分析宁波大学附属第一医院2022年8月至2024年12月期间收治的81例胆囊结石合并胆总管结石患者的临床资料,按手术方式分为两组,观察组(n=46)行单孔加一孔LCBDE一期缝合联合LC,对照组(n=35)行ERCP序贯三孔LC.比较两组患者手术时间,术中出血量,术前、术后白细胞(WBC)计数、C反应蛋白(CRP)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平,术后胆漏、ERCP术后胰腺炎(PEP)发生率,NRS评分,引流时间,总住院费用和住院时间等指标.结果 与对照组相比,观察组手术时间较长[140.00(124.80,156.30)min vs 98.50(77.00,114.50)min,Z=5.290,P<0.001]、术中出血量较多[10.00(5.00,12.50)mL vs 7.00(5.00,7.00)mL,Z=3.335,P=0.001],差异有统计学意义;但两组在术后炎症与肝功能指标方面的差异无统计学意义(P>0.05).观察组与对照组在术后胆漏[6(13.04%)vs 0,P=0.026]和PEP[0 vs 3(8.57%),P=0.043]发生率方面的差异有统计学意义.与对照组相比,观察组术后NRS评分、总住院费用更低,住院时间更短,差异具有统计学意义(P<0.05).结论 单孔加一孔LCBDE一期缝合联合LC对胆囊结石合并胆总管结石的疗效和安全性与ERCP序贯三孔LC相当,但其在术后疼痛控制、住院时间与费用方面更具优势.
Objective To analyze the efficacy of single-incision plus one-port laparoscopic common bile duct exploration(LCBDE)with primary suture combined with laparoscopic cholecystectomy(LC)versus endoscopic retrograde cholangiopancreatography(ERCP)followed by three-port LC in the treatment of cholecystolithiasis complicated by choledocholithiasis.Methods Clinical data of 81 patients with cholecystolithiasis complicated by choledocholithiasis treated in the First Affiliated Hospital of Ningbo University from August 2022 to December 2024 were retrospectively analyzed.Patients were divided into two groups:the observation group(n=46)underwent single-incision plus one-port LCBDE with primary suture combined with LC,and the control group(n=35)underwent ERCP followed by three-port LC.Operation time,intraoperative blood loss,pre-and postoperative levels of white blood cell(WBC)count,C-reactive protein(CRP),total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate aminotransferase(AST),incidence of postoperative bile leak and post-ERCP pancreatitis(PEP),Numerical Rating Scale(NRS)score,drainage duration,total hospitalization cost,and time of hospital stay were compared.Results Compared with the control group,the observation group had a longer operation time[140.00(124.80,156.30)min vs 98.50(77.00,114.50)min,Z=5.290,P<0.001]and greater intraoperative blood loss[10.00(5.00,12.50)mL vs 7.00(5.00,7.00)mL,Z=3.335,P=0.001].No significant differences were found in postoperative inflammatory and liver function markers(all P>0.05).The observation group and the control group showed a statistically significant difference in the incidence of postoperative bile leakage[6(13.04%)vs 0,P=0.026]and PEP[0 vs 3(8.57%),P=0.043].The observation group demonstrated lower postoperative NRS scores,lower total hospitalization costs,and a shorter time of hospital stay(all P<0.05).Conclusion For cholecystolithiasis complicated by choledocholithiasis,single-incision plus one-port LCBDE with primary suture combined with LC demonstrates comparable efficacy and safety to ERCP followed by three-port LC,while offering advantages in postoperative pain control,hospitalization costs,and time of hospital stay.
曹智凯;胡涛;李宇轩;杨晓平
宁波大学附属第一医院肝胆胰外科,浙江 宁波 315000宁波大学附属第一医院肝胆胰外科,浙江 宁波 315000宁波大学附属李惠利医院肝胆胰外科,浙江 宁波 315000宁波大学附属第一医院肝胆胰外科,浙江 宁波 315000
医药卫生
单孔加一孔腹腔镜胆总管探查腹腔镜胆囊切除术内镜逆行胰胆管造影胆囊结石胆总管结石一期缝合
single-incision plus one portlaparoscopic common bile duct explorationlaparoscopic cholecystectomyendoscopic retrograde cholangiopancreatographycholecystolithiasischoledocholithiasisprimary closure
《肝胆胰外科杂志》 2026 (1)
22-26,5
宁波市自然科学基金(2023J154).
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