三种手术方案治疗胆囊结石并胆总管结石的疗效及对血清GGT ALP的影响
|
摘要
目的:分析三种手术方案治疗胆囊结石并胆总管结石的疗效及对血清碱性磷酸酶(ALP)和γ-谷氨酰转肽酶(GGT)的影响。方法:分析我院于2015年2月至2017年3月收治的115例胆囊结石并胆总管结石患者,按照手术方式不同分为三组,31例患者采用腹腔镜胆囊切除术(LC)联合胆道镜胆总管探查术(LCBDE),即为A组; 45例采用LC联合经内镜逆行胰胆管造影(ERCP),即为B组; 39例采用传统开腹胆囊切除胆总管探查术(CBDE);即为C组。观察三组患者手术时间、术中出血量、术后禁食时间、术后排气时间、住院时间等手术指标,术后并发症发生情况及三组患者手术前后血清GGT、ALT水平变化,以及手术疗效。结果:A、B组手术时间、术中出血量、术后禁食时间、术后排气时间、住院时间均明显低于C组(P<0.05); A组术中出血量、术后排气时间与B组相当(P>0.05)。C组并发症发生率明显高于A、B组(P<0.05),A组与B组比较差异不具有统计学意义(P>0.05)。A、B、C三组术前GGT及ALP比较差异无统计学意义(P>0.05); A、B组GGT、ALP水平明显低于C组(P<0.05),A组GGT、ALP水平明显低于B组(P <0.05)。A、B组手术成功率明显高于C组(P <0.05),A、B组结石复发率明显低于C组(P>0.05); A组手术成功率明显高于B组(P>0.05),A组结石复发率明显低于B组(P>0.05),B组及C组各有1例结石残留,分别经再次ERCP及胆道镜取石后痊愈。结论:相对于传统开腹手术而言,微创联合手术治疗胆囊结石合并胆总管结石具有明显优势,其中LC+LCBDE手术各项指标均优于LC+ERCP,手术成功率高,术后并发症发生率、结石残留率、结石复发率均相对较低,可考虑将其作为治疗胆囊结石合并胆总管结石的主要术式。
Objective: To analyze the curative effect of three surgical schemes for cholecystolithiasis with common bile duct stones and their effects on serum alkaline phosphatase(ALP) and gamma-glutamyltransferase(GGT). Methods: 115 cases of cholecystolithiasis and choledocholithiasis treated in our hospital from February 2015 to March 2017 were analyzed and divided into 3 groups according to different operative methods,among them,31 patients were treated with laparoscopic cholecystectomy(LC) combined with choledochoscopy common bile duct exploration(LCBDE),named group A; 45 cases were treated with LC combined with endoscopic retrograde cholangiopancreatography(ERCP),named group B; 39 cases were treated with traditional open cholecystectomy choledochal exploration(CBDE),named group C. The operation index,postoperative complications,and the changes of serum GGT and ALT levels of patients in 3 groups before and after operation,and the effect of operation were observed. Results: The operative time,intraoperative blood loss,postoperative fasting time,postoperative exhaust time and length of stay in group A and group B were significantly lower than those in group C(P <0.05); the intraoperative blood loss and postoperative exhaust time in group A were approximately equal to those in group B(P >0.05). The incidence of complications in group C was significantly higher than that in group A and group B(P <0.05),and the difference between group A and group B was not statistically significant(P >0.05). There was no significant difference in GGT and ALP between the three groups of A,B and C before operation(P >0.05); the levels of GGT and ALP in group A and group B were significantly lower than those in group C(P <0.05),and GGT and ALP levels in group A were significantly lower than those in group B(P <0.05). The success rate of operation in group A and group B was significantly higher than that in group C(P <0.05),and the stones recurrence rate in group A and group B was significantly lower than that in group C(P >0.05); the success rate of operation in group A was significantly higher than that in group B(P >0.05),the stone recurrence rate in group A was significantly lower than that in group B(P >0.05),and group B and group C had one case of residual stones respectively,and recovered after repeated ERCP and choledochoscopy. Conclusion: Compared with traditional open surgery,minimally invasive combined operation has obvious advantages in treating cholecystolithiasis and choledocholithiasis,all the indexes of LC+LCBDE operation are better than that of LC+ERCP,the success rate of operation is high,the incidence rate of postoperative complications,the stones residual rate and the stones recurrence rate are relatively low,which can be considered as the main operation for the treatment of cholecystolithiasis and choledocholithiasis.
Objective: To analyze the curative effect of three surgical schemes for cholecystolithiasis with common bile duct stones and their effects on serum alkaline phosphatase(ALP) and gamma-glutamyltransferase(GGT). Methods: 115 cases of cholecystolithiasis and choledocholithiasis treated in our hospital from February 2015 to March 2017 were analyzed and divided into 3 groups according to different operative methods,among them,31 patients were treated with laparoscopic cholecystectomy(LC) combined with choledochoscopy common bile duct exploration(LCBDE),named group A; 45 cases were treated with LC combined with endoscopic retrograde cholangiopancreatography(ERCP),named group B; 39 cases were treated with traditional open cholecystectomy choledochal exploration(CBDE),named group C. The operation index,postoperative complications,and the changes of serum GGT and ALT levels of patients in 3 groups before and after operation,and the effect of operation were observed. Results: The operative time,intraoperative blood loss,postoperative fasting time,postoperative exhaust time and length of stay in group A and group B were significantly lower than those in group C(P <0.05); the intraoperative blood loss and postoperative exhaust time in group A were approximately equal to those in group B(P >0.05). The incidence of complications in group C was significantly higher than that in group A and group B(P <0.05),and the difference between group A and group B was not statistically significant(P >0.05). There was no significant difference in GGT and ALP between the three groups of A,B and C before operation(P >0.05); the levels of GGT and ALP in group A and group B were significantly lower than those in group C(P <0.05),and GGT and ALP levels in group A were significantly lower than those in group B(P <0.05). The success rate of operation in group A and group B was significantly higher than that in group C(P <0.05),and the stones recurrence rate in group A and group B was significantly lower than that in group C(P >0.05); the success rate of operation in group A was significantly higher than that in group B(P >0.05),the stone recurrence rate in group A was significantly lower than that in group B(P >0.05),and group B and group C had one case of residual stones respectively,and recovered after repeated ERCP and choledochoscopy. Conclusion: Compared with traditional open surgery,minimally invasive combined operation has obvious advantages in treating cholecystolithiasis and choledocholithiasis,all the indexes of LC+LCBDE operation are better than that of LC+ERCP,the success rate of operation is high,the incidence rate of postoperative complications,the stones residual rate and the stones recurrence rate are relatively low,which can be considered as the main operation for the treatment of cholecystolithiasis and choledocholithiasis.
引文
[1] Tazuma S,Unno M,Igarashi Y,et al. Evidence-based clinical practice guidelines for cholelithiasis 2016.[J]. Journal of Gastroenterology,2016,52(3):1~25.
[2] Yu L I,Hao J,Sun H,et al. One-staged laparoscopic cholecystectomy and common bile duct exploration versus twostaged endoscopic stone extraction followed by laparoscopic cholecystec-tomy for concomitant cholecystolithiasis and choledocholithiasis[J]. Chinese Journal of General Surgery,2016,25(2):202~208.
[3]游勤建,袁发秀,宋平.腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石的疗效对比[J].河北医学,2016,22(5):721~724.
[4]顾强,汪意清.腹腔镜胆囊切除联合胆总管切开取石T管引流与传统开腹手术近远期疗效对比研究[J].临床外科杂志,2017,25(10):799~800.
[5]王伟艺,涂彦渊,袁祖荣,等.胆总管结石合并胆囊结石老年患者腹腔镜与传统手术治疗比较[J].老年医学与保健,2017,23(1):19~22.
[6]薛红娣,刘双海,陈胜,等.腹腔镜下胆囊切除术治疗胆结石患者的疗效及对机体免疫功能的影响[J].医学综述,2016,22(24):4914~4916.
[7]马大喜,李可为,王坚,等.LC+LCBDE和ERCP/EST+LC在胆囊合并胆总管结石中应用的随机对照研究[J].肝胆胰外科杂志,2016,28(6):448~453.
[8]杨如高,连立之,张佳文.三种不同手术方式治疗胆囊结石合并胆总管结石的疗效及安全性分析[J].肝胆外科杂志,2017,25(1):30~33.
[9]李宇,郝杰,孙昊,等.一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较[J].中国普通外科杂志,2016,25(2):202~208.
[10]王春丽.LC术前行ERCP+EST治疗高龄胆囊结石合并胆总管结石患者的近期疗效[J].检验医学与临床,2017,14(12):1815~1817.
[11]张建涛,吴畏,钱惠岗,等.不同手术方案在复杂胆总管结石患者中的效果研究[J].中国内镜杂志,2016,22(2):11~14.
[12]吕桂芳,张春,陈丹丹,等.血清γ-谷氨酰转移酶与碱性磷酸酶在胆囊结石合并胆总管小结石诊断中的临床意义[J].中外医学研究,2015,13(18):58~59.
[13]杨海军,赵海滨,杜峰华,等.血清γ-谷氨酰转移酶、碱性磷酸酶在胆总管小结石诊断中的临床价值[J].海军医学杂志,2017,38(6):517~520.
[2] Yu L I,Hao J,Sun H,et al. One-staged laparoscopic cholecystectomy and common bile duct exploration versus twostaged endoscopic stone extraction followed by laparoscopic cholecystec-tomy for concomitant cholecystolithiasis and choledocholithiasis[J]. Chinese Journal of General Surgery,2016,25(2):202~208.
[3]游勤建,袁发秀,宋平.腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石的疗效对比[J].河北医学,2016,22(5):721~724.
[4]顾强,汪意清.腹腔镜胆囊切除联合胆总管切开取石T管引流与传统开腹手术近远期疗效对比研究[J].临床外科杂志,2017,25(10):799~800.
[5]王伟艺,涂彦渊,袁祖荣,等.胆总管结石合并胆囊结石老年患者腹腔镜与传统手术治疗比较[J].老年医学与保健,2017,23(1):19~22.
[6]薛红娣,刘双海,陈胜,等.腹腔镜下胆囊切除术治疗胆结石患者的疗效及对机体免疫功能的影响[J].医学综述,2016,22(24):4914~4916.
[7]马大喜,李可为,王坚,等.LC+LCBDE和ERCP/EST+LC在胆囊合并胆总管结石中应用的随机对照研究[J].肝胆胰外科杂志,2016,28(6):448~453.
[8]杨如高,连立之,张佳文.三种不同手术方式治疗胆囊结石合并胆总管结石的疗效及安全性分析[J].肝胆外科杂志,2017,25(1):30~33.
[9]李宇,郝杰,孙昊,等.一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较[J].中国普通外科杂志,2016,25(2):202~208.
[10]王春丽.LC术前行ERCP+EST治疗高龄胆囊结石合并胆总管结石患者的近期疗效[J].检验医学与临床,2017,14(12):1815~1817.
[11]张建涛,吴畏,钱惠岗,等.不同手术方案在复杂胆总管结石患者中的效果研究[J].中国内镜杂志,2016,22(2):11~14.
[12]吕桂芳,张春,陈丹丹,等.血清γ-谷氨酰转移酶与碱性磷酸酶在胆囊结石合并胆总管小结石诊断中的临床意义[J].中外医学研究,2015,13(18):58~59.
[13]杨海军,赵海滨,杜峰华,等.血清γ-谷氨酰转移酶、碱性磷酸酶在胆总管小结石诊断中的临床价值[J].海军医学杂志,2017,38(6):517~520.