本文選題：膽囊結(jié)石 + 膽總管結(jié)石　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過回顧性分析腹腔鏡術(shù)前或術(shù)中聯(lián)合十二指腸鏡治療膽囊結(jié)石合并膽總管結(jié)石的臨床療效,探討在不同時(shí)期使用雙鏡聯(lián)合治療的安全性及可行性,并通過對(duì)比術(shù)后并發(fā)癥的發(fā)生率以指導(dǎo)臨床決策,為合理選擇雙鏡聯(lián)合治療膽囊結(jié)石合并膽總管結(jié)石的方式提供可靠參考和依據(jù)。方法:按照納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選出2015年1月1日至2017年2月28日符合條件的采用雙鏡聯(lián)合治療的膽囊結(jié)石合并膽總管結(jié)石的患者,按照其行十二指腸鏡的時(shí)期不同,將其分為術(shù)前ERCP/EST/ENBD/EPBD+LC組(Pre-ERCP+LC)和術(shù)中ERCP/EST/ENBD/EPBD+LC組(Io-ERCP+LC),兩組的手術(shù)操作均由熟練掌握腹腔鏡及內(nèi)鏡操作診療技術(shù)的專業(yè)人員負(fù)責(zé)實(shí)施,比較兩組患者性別組成,年齡,實(shí)驗(yàn)室檢查,肝功能分級(jí),膽囊結(jié)石及膽總管結(jié)石直徑的大小,膽總管直徑等基本臨床資料,通過比較兩組病例的手術(shù)完成情況,手術(shù)指標(biāo),并發(fā)癥指標(biāo)及術(shù)后指標(biāo)來(lái)評(píng)價(jià)其臨床療效,以分析不同階段應(yīng)用雙鏡聯(lián)合的治療效果及安全性。結(jié)果:兩組性別組成,年齡,實(shí)驗(yàn)室檢查,肝功能分級(jí),膽囊結(jié)石及膽總管結(jié)石直徑大小,膽總管直徑等基本臨床資料均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組患者臨床資料具有可比性。兩組患者在手術(shù)時(shí)間,術(shù)中出血,結(jié)石清除率,結(jié)石殘留率上均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),表明不同時(shí)期進(jìn)行的手術(shù)治療在兩組患者其治療結(jié)石的臨床療效都是沒有差異的,在術(shù)后并發(fā)癥方面,Pre-ERCP+LC組總并發(fā)癥發(fā)生率24.1%,Io-ERCP+LC組總并發(fā)癥發(fā)生率36.4%,兩組患者中均未出現(xiàn)誤吸,消化道穿孔,急性膽管炎,膽漏,膽道損傷等嚴(yán)重并發(fā)癥,但不同程度的PEP及高胰酶血癥仍是發(fā)生率較高的并發(fā)癥,且在兩組之間沒有明顯差異(P0.05),但兩組患者在整個(gè)治療過程中的NRS疼痛評(píng)分,手術(shù)費(fèi)用及住院時(shí)間上有明顯差異,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),Io-ERCP+LC組患者疼痛評(píng)分較低,住院時(shí)間更短,費(fèi)用花費(fèi)更少,術(shù)后隨訪1-3個(gè)月兩組病例均未出現(xiàn)結(jié)石復(fù)發(fā),膽管炎等并發(fā)癥。結(jié)論:術(shù)中及術(shù)前十二指腸鏡聯(lián)合腹腔鏡治療膽囊結(jié)石合并膽總管結(jié)石這兩種不同階段的手術(shù)方式在結(jié)石清除方面具有較好的臨床療效并且安全可行,短期隨訪無(wú)結(jié)石復(fù)發(fā)。而術(shù)中同期行十二指腸鏡聯(lián)合腹腔鏡的治療方式在保證同樣的臨床療效下,能夠減少患者因操作產(chǎn)生的不適,使患者在治療過程中痛苦更少,提高患者耐受手術(shù)的能力,還能夠縮短住院時(shí)間,減少手術(shù)費(fèi)用。
[Abstract]:Objective: to retrospectively analyze the clinical effect of laparoscopic combined duodenoscopy before and during operation on cholecystolithiasis complicated with choledocholithiasis, and to explore the safety and feasibility of using double-mirror combined therapy in different stages of cholecystolithiasis and choledocholithiasis. By comparing the incidence of postoperative complications to guide the clinical decision-making, and to provide a reliable reference and basis for the reasonable selection of double-mirror combined treatment of cholecystolithiasis combined with choledocholithiasis. Methods: according to the inclusion criteria and exclusion criteria, patients with cholecystolithiasis combined with choledocholithiasis were selected from January 1, 2015 to February 28, 2017, according to the period of duodenoscopy. It was divided into preoperative ERCP/EST/ENBD/EPBD LC group (Pre-ERCP LC) and intraoperative ERCP/EST/ENBD/EPBD LC group (Io-ERCP LC). The operation of the two groups was performed by professionals who were skilled in laparoscopy and endoscopic operation. The sex composition, age, and laboratory examination of the two groups were compared. The basic clinical data such as liver function grade, diameter of gallstone and choledocholithiasis, diameter of choledochus, and so on, were compared to evaluate the clinical effect of the two groups by comparing the operation completion, operation index, complication index and postoperative index. To analyze the efficacy and safety of double-mirror combination in different stages. Results: there were no significant differences in sex, age, laboratory examination, liver function grade, diameter of gallstone and common bile duct stone, diameter of common bile duct between the two groups (P 0.05). The clinical data of the two groups were comparable. There was no significant difference in operation time, intraoperative bleeding, stone clearance rate and stone residual rate between the two groups. The total complication rate of pre-ERCP LC group was 24.1% and that of Io-ERCP LC group was 36.4%. There were no serious complications such as aspiration, perforation of digestive tract, acute cholangitis, bile leakage and biliary tract injury in both groups. However, the incidence of PEP and hyperlipidemia was still high, and there was no significant difference between the two groups (P 0.05). However, there were significant differences in NRS pain score, operation cost and hospital stay between the two groups during the whole course of treatment. The difference was statistically significant in the patients with Io-ERCP LC. The pain score was lower, the hospitalization time was shorter, and the cost was lower. There were no complications such as calculi recurrence and cholangitis in the follow-up of 1-3 months after operation. Conclusion: the operative methods of cholecystolithiasis combined with choledocholithiasis at different stages of operation and preoperative duodenoscopy combined with laparoscopy have better clinical efficacy and safety and feasibility in the removal of gallstones, and there is no recurrence of stones in short-term follow-up. Meanwhile, under the same clinical effect, the treatment of duodenoscopy combined with laparoscopy during the same period of operation can reduce the discomfort caused by the operation, reduce the pain and improve the patient's ability to tolerate the operation. It can also shorten the hospital stay and reduce the cost of operation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4

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