Analysis of the efficacy and safety of ERCP/EST combined with laparoscopic cholecystectomy in the treatment of common bile duct stones with acute cholangitis and gallbladder stones
ERCP/EST联合腹腔镜胆囊切除术治疗胆总管结石伴急性胆管炎及胆囊结石的效果及安全性分析

摘要

目的 探讨ERCP/EST（内镜下逆行胰胆管造影/内镜下乳头括约肌切开术）联合腹腔镜胆囊切除术（LC）治疗胆总管结石合并急性胆管炎及胆囊结石的临床疗效与安全性。方法 2020年2月-2025年1月，选取76例胆总管结石伴急性胆管炎及胆囊结石患者，根据手术方案不同分为观察组（n=38）与对照组（n=38），观察组采用ERCP/EST联合腹腔镜胆囊切除术的一期治疗方案，对照组采用腹腔镜胆囊切除联合胆总管探查取石术（LCBDE）一期治疗方案，对比两组治疗效果。结果 观察组术中出血量较少，术后肛门排气时间较短，术后住院时间较短，优于对照组（P<0.05）。两组结石一次性清除率无显著差异（P>0.05），但观察组术后并发症总发生率显著低于对照组（P<0.05）。术后观察组白细胞计数（WBC）和C反应蛋白（CRP）水平下降幅度更显著（P<0.05）。结论 对于胆总管结石伴急性胆管炎及胆囊结石患者，采用ERCP/EST联合LC的分阶段治疗方案效果更好，值得临床推广。

Abstract

Objective To investigate the clinical efficacy and safety of ERCP/EST combined with laparoscopic cholecystectomy (LC) in the treatment of common bile duct stones with acute cholangitis and gallstones.
Methods From February 2020 to January 2025, 76 patients with common bile duct stones accompanied by acute cholangitis and gallstones were selected and divided into an observation group (n=38) and a control group (n=38) according to different surgical plans. The observation group received a one-stage treatment plan of ERCP/EST combined with laparoscopic cholecystectomy, while the control group received a one-stage treatment plan of laparoscopic cholecystectomy combined with common bile duct exploration and stone extraction (LCBDE). The treatment effects of the two groups were compared.
Results The observation group had less intraoperative bleeding, shorter postoperative anal exhaust time, and shorter postoperative hospitalization time, which was better than the control group (P<0.05). There was no significant difference in the one-time stone clearance rate between the two groups (P>0.05), but the total incidence of postoperative complications in the observation group was significantly lower than that in the control group (P<0.05). The postoperative observation group showed a more significant decrease in white blood cell count (WBC) and C-reactive protein (CRP) levels (P<0.05).
Conclusion   For patients with common bile duct stones accompanied by acute cholangitis and gallstones, the staged treatment plan of ERCP/EST combined with LC is more effective and worthy of clinical promotion.