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| The Effectiveness of Combined Staged Laparoscopic Surgery in the Treatment of Acute Common Bile Duct and Gallbladder Stones |
| LIU Yunhan, WANG Chao, WANG Linlin, et al |
| Operating Room, Shandong Provincial Third Hospital, Jinan Shandong 250031 |
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Abstract 【Objective】 To investigate the effectiveness of combined staged laparoscopic surgery in treating patients with acute common bile duct and gallbladder stones.【Methods】 Sixty patients admitted to two hospitals with acute common bile duct and gallbladder stones were randomly divided into an observation group and a control group, with 30 patients in each. The control group underwent simultaneous total laparoscopic surgery [laparoscopic common bile duct exploration (LCBDE) + laparoscopic cholecystectomy (LC)], while the observation group underwent combined staged laparoscopic surgery [endoscopic sphincterotomy (EST) + endoscopic retrograde cholangiopancreatography (ERCP) + LC]. Surgical related indicators, pre- and post-operative intestinal flora levels, post-operative complications and prognosis were compared between the two groups.【Results】The operation time, post-operative time to first flatus, and post-operative hospital stay in the observation group were shorter than those in the control group (P<0.05). The intraoperative blood loss was also less in the observation group (P<0.05). Compared to the control group, the levels of E. coli and Enterococcus were lower, while the level of Bifidobacterium was higher in the observation group post-operatively (P<0.05). The rates of post-operative fever and acute pancreatitis were 3.33% and 6.67%, respectively, in the observation group, which were lower than 26.67% and 23.33% in the control group (P<0.05). There were no significant differences in the rates of post-operative bleeding, wound infection, and peritoneal infection between the groups (P>0.05).【Conclusion】 Combined staged laparoscopic surgery not only shortens the surgery time, post-operative time to first flatus, and post-operative hospital stay, reduces intraoperative blood loss, but also improves intestinal flora levels in patients with acute common bile duct and gallbladder stones. Moreover, it offers higher safety and better long-term prognosis.
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Received: 15 October 2023
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[1] 王恒毅,汤亲青,王兴宇,等.LC联合LTCBDE在老年急性胰腺炎合并胆囊结石伴胆总管结石患者中的应用及安全性研究[J].肝胆外科杂志,2017,25(3):195-199.
[2] 赵今,张建,丁俊.一期腹腔镜手术与分期内镜加腹腔镜手术治疗胆囊结石合并胆总管结石的临床效果和安全性比较[J].广西医学,2023,45(11):1273-1277.
[3] ALMUSAWI J, NAVARATNE L, MARTINEZISLA A. Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy[J].Am J Surg,2018,217(1):188-189.
[4] 方骏,王安,孙修勇,等.三镜联合分期手术与腹腔镜手术治疗老年胆总管结石合并胆囊结石患者疗效对比研究[J].实用肝脏病杂志,2022,25(5):730-733.
[5] 中国中西医结合学会消化系统疾病专业委员会.胆石症中西医结合诊疗共识[J].中国中西医结合杂志,2011,31(8):1041-1043.
[6] PAL A K, SINGH D, SONKAR A A, et al. Re: Single-incision versus 3-port laparoscopic cholecystectomy in symptomatic gallstones: a prospective randomized study[J].Surgery,2017,62(6):1347.
[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.肝胆胰外科杂志[J].2016,28(6):448-453.
[8] 王维,陈安平,刘安,等.同期三镜联合手术与分期两镜手术治疗胆囊结石合并胆总管结石的疗效对比[J].中国内镜杂志,2020,26(2):23-27.
[9] 何亚红,汤小伟,沈红璋,等.合并胆囊结石的胆总管结石内镜取石术后是否保留胆囊的病例对照研究[J].中华消化内镜杂志,2017, 34(12):877-881.
[10] 武淼,周铁,王轶,等.同期三镜联合手术与分期两镜手术治疗胆总管结石合并胆囊结石的对比研究[J].国际外科学杂志,2021,48(4):254-259.
[11] 杨素坚,彭秀琨.腹腔镜胆囊切除术后促进胃肠道功能恢复的中医护理研究[J].中外医学研究,2016,14(9):124-125.
[12] HEO J, JUNG M K, CHO C M.Should prophylactic cholecystectomy be performed in patients with concomitant gallstones after endoscopic sphincterotomy for bile duct stones[J].Surg Endosc,2015,29(6):1574-1579.
[13] 汪晓峰,郑杨,陈嘉希,等.“三步法”在十二指肠乳头括约肌切开术后行腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石手术时机选择的应用[J].中国普通外科杂志,2018,27(8):976-982.
[14] 陈钰,杜静虎,王东华,等.LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石的临床效果比较[J].肝胆胰外科杂志,2018,30(5):57-60. |
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2024, Vol. 41 
