内镜逆行胰胆管造影联合近期腹腔镜胆囊切除治疗胆系结石的可行性分析与体会

目的探讨经内镜逆行胰胆管造影（ERCP）联合近期（3 d内）腹腔镜胆囊切除术（LC）彻底治疗胆系结石的可行性。方法回顾性分析2012年1月至2014年1月首都医科大学附属北京天坛医院普通外科收治的胆囊结石胆囊炎合并胆总管结石及胆道感染的46例患者,ERCP后1-3 d内行LC的患者21例,设为实验组;ERCP后1-3个月行LC的患者25例,设为对照组。对比两组患者LC手术时间,术中出血量,术后腹腔引流量,中转开腹率,胆囊部分切除率,LC手术前后直接胆红素、谷丙转氨酶及血清淀粉酶含量。结果两组患者在手术时间、术中出血量、术后腹腔引流量、中转开腹率、胆囊部分切除率之间比较,差异无统计学意义（P=0.385、0.242、0.796、0.836、1.000）;实验组术前直接胆红素（16.80±4.38）vs（7.86±3.35）,P=0.000]、谷丙转氨酶（60.33±21.01）vs（45.66±19.69）,P=0.019]及血清淀粉酶值（69.61±39.71）vs（45.70±16.67）,P=0.009]均高于对照组,术后两组间直接胆红素、谷丙转氨酶、血清淀粉酶比较,差异无统计学意义（P=0.365、0.114、0.316）。结论 ERCP联合近期内行LC彻底治疗胆系结石是可行的。掌握此时期手术的所需技巧,可以达到安全、尽早彻底治疗患者胆系结石及炎症。

Feasibility analysis of ERCP combined with recent laparoscopic cholecystectomy for treatment of the biliary calculi

Objective To explore the feasibility of endoscopic retrograde cholangiopancreatography（ ERCP） combined with recent（ with in 3 days） laparoscopic cholecystectomy（ LC） for treatment of the biliary calculi. Methods Forty-six cases in Beijing Tiantan Hospital Affitiated to Capital Medical University gallstone and biliary stones with biliary tract infection from 2012 January to 2014 January,21 patients were performed LC 3 days after ERCP,for the experimental group,25 patients were performed LC by traditional treatment methods,1-3 months after ERCP,for the control group. Contrast operative time,surgery bleeding,postoperative abdominal drainage,rate of laparotomy and partial cholecystectomy,the direct bilirubin,alanine aminotransferaes and serum amylase preoperative and postoperative. Results There were no significant differences between the two groups in operative time（ P = 0. 385）,blood loss（ P =0. 242）, postoperative abdominal drainage（ P = 0. 796）, laparotomy（ P = 0. 836） and partial cholecystectomy rate（ P = 1. 000）. The direct bilirubin（ P = 0. 000）,alanine aminotransferaes（ P = 0. 019）and serum amylase（ P = 0. 009） in the patients of experimental group were higher than patients of control group,but there were no significant differences between the two groups of the direct bilirubin（ P = 0. 365）,alanine aminotransferaes（ P = 0. 114） and serum amylase（ P = 0. 316）. Conclusions ERCP combined with recent（ with in 3 days） laparoscopic cholecystectomy（ LC） for treatment of the biliary calculi is feasible. With skills required for surgery in this period,the anthors can safely cure gallstone and biliary stones with biliary tract infection as early as possible.