LC联合ERCP同期手术治疗胆囊结石合并胆总管结石临床疗效观察及机制分析OA

Objective To compare the clinical efficacy and safety of concurrent one-stage laparoscopic cholecystecto-my(LC)combined with endoscopic retrograde cholangiopancreatography(ERCP)with staged procedures for patients with cholecystolithiasis complicated with choledocholithiasis,and to investigate the underlying mechanisms with regard to Toll-like receptor 4(TLR4)pathway,inflammatory response,stress response and immune function.Methods Ninety-six pa-tients with cholecystolithiasis and choledocholithiasis were enrolled and assigned into the concurrent group(n=48,one-stage combined surgery)and the staged group(n=48,ERCP followed by LC 2-4 days later).Perioperative outcomes,in-cluding operation time,intraoperative blood loss and length of hospital stay,were recorded.Stone clearance rate at 1 week postoperatively was evaluated.Levels of stress markers including white blood cell(WBC)count,adrenocorticotropic hor-mone(ACTH)and cortisol(Cor),immune parameters including immunoglobulin G(IgG),immunoglobulin A(IgA)and immunoglobulin E(IgE),as well as serum TLR4,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were meas-ured and compared between the two groups.Postoperative complications and recurrence rate were also assessed.Results The concurrent group exhibited significantly shorter hospital stay,less intraoperative blood loss and lower complication rate than the staged group(all P＜0.05).No significant differences were detected in operation time,stone clearance rate or re-currence rate between the two groups.There were no significant intergroup differences in postoperative stress or immune in-dices.However,serum levels of TLR4,IL-6 and TNF-α were significantly lower in the concurrent group than in the staged group(all P＜0.05).Conclusions Concurrent one-stage LC combined with ERCP yields satisfactory and comparable stone clearance for cholecystolithiasis with choledocholithiasis relative to staged surgery.The concurrent strategy is associated with reduced intraoperative blood loss,shorter hospital stay and fewer postoperative complications.The beneficial effects may be related to the avoidance of secondary surgical insult and the suppression of TLR4-mediated inflammatory response.