关键词: 经内镜逆行胰胆管造影术, 腹腔镜胆总管探查Ⅰ期缝合, 腹腔镜胆囊切除术, 胆总管结石, 临床疗效

Abstract: Objective To compare the performances of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LBEPS) on the patients suffering from gallbladder (GS) and common bile duct stones (CBDS). Methods The clinical data of 82 patients treated for GS and CBDS in our hospital from May 2017 to February 2022 were enrolled and divided into two groups: the LBEPS+LC group(43 cases) and the ERCP+LC group(39 cases ) according to different surgical plans. Between the two groups, quality of life, liver function indexes, pancreatic injury indexes, surgery-related indexes were compared. Results LCBDE+LC group had a shorter mean(SD) postoperative length of stay (11.28±3.45 d vs 14.64±4.27 d, P<0.05) and operation time (86.72±16.54 min vs 112.42±20.57 min, P<0.05). In the LCBDE+LC group the intraoperative blood loss was significantly lower than that in the ERCP+LC group(41.83±7.59ml vs 46.89±9.61ml, P<0.05). There was no significant difference in complications between the two groups (P>0.05). On postoperative day 1(POD1), the LCBDE+LC group showed remarkable increases in serum levels of amylase (AMY) (102.41±11.59 U/L vs 81.53±7.96 U/L), alanine aminotransferase (ALT) (61.28±5.24 U/L vs 35.87±3.21 U/L) and alkaline phosphatase (ALP) (91.59±8.35 U/L vs 75.41±6.92 U/L) than pre-operatively (P<0.05). In the ERCP+LC group, ALT (60.75±5.63 U/L vs 35.49±3.46 U/L), ALP (90.62±8.11 U/L vs 76.83±6.57 U/L), and AMY (110.84±12.43 U/L vs 82.75±7.42 U/L) were also higher than pre-operatively (P<0.05) . There was no significant difference in ALP and ALT between the two groups on POD1 (P>0.05). While serum level of AMY in the LCBDE+LC group was significantly lower than in the ERCP+LC group on POD1(102.41±11.59 U/L vs 110.84±12.43 U/L, P<0.05). At 3 months after operation, the Short- Form Health Survey (SF-36) scores increased in both groups(P<0.05), while no difference was found in the SF-36 scores between the two groups (P>0.05).Conclusion Both protocols have therapeutic effect, but LBEPS combined with LC is more efficacious in ameliorating pancreatic damage, shortening postoperative length of stay and operation time, and reducing surgical trauma.

Key words: Endoscopic retrograde cholangiopancreatography, Laparoscopic common bile duct exploration with stage I suture, Laparoscopic cholecystectomy, Common bile duct stones, Clinical efficacy