功能性消化不良患者胆囊排空及激素水平的研究

目的研究胆囊排空及血浆胃肠激素水平变化在功能性消化不良(FD)发病机制中的作用.方法采用放射性核素序列成像和放免技术检测20例健康志愿者(对照组)和32例功能性消化不良患者(FD组)空腹及餐后胆囊排空指数和血浆胃动素(MTL)、胆囊收缩素(CCK)、血管活性肠肽(VIP)和生长抑素(SS)水平.结果FD组空腹及餐后胆囊排空指数均明显低于对照组,差异有非常显著性(P＜0.001);FD组空腹及餐后血浆MTL值均低于对照组,差异有非常显著性(P＜0.001),MTL值与胆囊排空指数呈正相关(r空腹=0.82,P＜0.01,r餐后=0.94,P＜0.01);FD组空腹血浆CCK值与对照组比较,差异无显著性(P＞0.05),餐后差异有非常显著性(P＜0.001),CCK值与胆囊排空指数呈显著正相关(r=0.97,P＜0.01);FD组空腹与餐后血浆VIP值均高于对照组,差异有非常显著性(P＜0.001),VIP值与胆囊排空指数呈负相关(r空腹=-0.81,P＜0.01,r餐后=-0.47,P＜0.01);FD组空腹及餐后血浆SS值与对照组相比,差异无显著性(P＞0.05).结论(1)FD患者存在空腹及餐后胆囊排空下降,血浆促胃肠动力激素(MTL、CCK)水平下降和抑制胃肠动力激素(VIP)水平升高,可能是其病因和发病机制之一;(2)放射性核素胆囊序列成像无创、安全,可作定量分析及动态观察,值得推广应用.     

肝硬化患者血浆胆囊收缩素及胃动素对胃排空的影响

目的本研究旨在探讨肝硬化患者胃排空功能,并探讨其胃排空作用与空腹血浆胆囊收缩素、胃动素的关系,进而为预防和治疗肝硬化提供参考。方法 将30例肝硬化患者作为试验组,30例健康志愿者作为对照组,采用^13C-辛酸呼气试验法测定肝硬化患者以及对照组的胃固体半排空时间（GET1／2）,同时用放射免疫技术测定患者及对照组的空腹血浆胆囊收缩素（CCK）及胃动素（MTL）水平。结果与健康志愿者组相比,肝硬化患者组GET1／2明显延迟（P〈0．05）;空腹血浆CCIK及MTL水平明显升高,组间差异有统计学意义（P〈0．05）;患者GET1／2与空腹血浆CCK及MTL水平各自呈正相关。结论肝硬化患者胃排空延迟可能与血浆CCK及MTL水平的异常增高相关。推测肝硬化时血浆CCK及MTL水平均明显增高,由此引发胃排空延迟,最终导致营养不良,进而加重患者病情。     

肝硬化患者血浆VIP、CCK水平与胆囊排空功能的关系

探讨肝硬化时血浆胃肠激素水平对胆囊运动的影响。用放免法测定肝硬化患者及对照者血浆血管活性肠肽 (VIP)和胆囊收缩素 (CCK)含量 ;用B超测定餐前、餐后胆囊容积及排空率。结果 :肝硬化时血浆VIP、CCK均明显增高 (P <0 0 1,P <0 0 5 ) ;胆囊空腹容积、剩余容积均明显增大 (P <0 0 1,P <0 0 0 1) ,最大排空率较对照组无明显差异 (P >0 0 5 ) ,但Child -PughC级降低 (P <0 0 5 )。肝硬化组胆囊最大排空率与VIP呈负相关 ,胆囊空腹容积及剩余容积与VIP均呈正相关 ,胆囊空腹容积、剩余容积及最大排空率与CCK均无相关。提示肝硬化时VIP增高既抑制胆囊运动 ,又明显降低胆囊张力 ,肝硬化时可能存在对CCK的抵抗。     

EST与LC联合治疗胆囊结石合并胆总管结石疗效观察

目的观察十二指肠镜下十二指肠乳头括约肌切开术（EST）联合腹腔镜胆囊切除术（LC）治疗胆囊结石合并胆总管结石的疗效。方法将90例胆囊结石合并胆管结石患者随机分为治疗组和对照组,各45例。治疗组行EST联合LC,对照组行传统开腹胆管探查T管引流术。结果治疗组手术成功率为95.6%,对照组为91.1%（P〉0.05）;治疗组术后并发症发生率为8.9%,显著低于对照组的20.0%（P〈0.05）,治疗组术后胃肠道功能恢复时间和平均住院时间较对照组显著缩短（P〈0.05）。结论 EST与LC联合治疗胆囊结石合并胆总管结石安全、有效。     

内镜下十二指肠乳头括约肌切开和球囊扩张对胆囊功能影响的研究

目的探讨内镜下胆总管取石术中十二指肠乳头括约肌不同处理方式对患者术后胆囊功能的影响。方法选择58名曾经接受内镜下胆总管取石术的患者,根据治疗方式不同分为3组,十二指肠乳头括约肌大切开组21例、中小切开组20例、球囊扩张组17例,另选择20例健康体检者作为对照。所有患者均采用^99m Tc—EHIDA肝胆动态核素显像进行定量分析,通过肝脏半排时间（TEK）,胆总管高峰时间（CBD Tup）,胆囊显影时间（GBVT）,胆囊的半排时间（GBT1/2）,30min胆囊排空分数（GBEF30min）,30min胆囊排空率（GBER 30min）,十二指肠显影时间（DUT）,十二指肠高峰时间（DU Tup）和胆肠分配比（Fgb,Fsi）综合评价胆囊的功能。结果括约肌大切开组分别与其余两治疗组及对照组比较,TEX明显缩短（P〈0．05）;CBD Tup、DUT、DU Tup出现的时间较早（P〈0．05）;GBVT时间延迟（P〈0．001）;GBT1／2缩短（P〈0．001）,GBEF30min较大（P〈0．001）,GBER 30min较快（P〈0．001）,胆肠分配比胆囊的比例Fgb明显减少（P〈0．001）,肠道比例Fsi增加（P〈0．001）。EST中小切开组、EBPD组和对照组各参数比较,差异均无统计学意义（P〉0．05）。结论EST大切开患者胆囊贮存功能明显受损,排泄功能增强;EST中小切开及EPBD患者胆囊贮存及排泄功能无明显改变。     

肌注Ceruletide后胆管测量作为超声诊断胆管结石的辅助方法

近来超声的敏感性进展很快,但诊断胆管结石仍感困难,特别在胆管扩大而无阻塞或胆管有结石但不扩大时。作者给一组疑为胆总管结石患者肌注Ceruletide,注射Ceruletide前、后作超声检查以观察胆总管管径的变化。该药可使胆汁流量增加,胆囊收缩,十二指肠括约肌开放。其作用与CCK相仿而没有CCK的副作用,较脂肪餐容易定量,且作用较强。     

十二指肠胃反流与胆囊切除术关系的临床研究

目的　通过对胆石症和胆囊切除术后出现胆汁反流性胃炎患者的血清胃动素 (MTL)和胆囊收缩素 (CCK)检测 ,探讨十二指肠胃反流 (DGR)的发生机制。方法　对确诊胆汁反流性胃炎的胆囊切除术后患者 (A组 ,30例 )和胆石症合并胆汁反流性胃炎患者 (B组 ,2 2例 ) ,以及对照组 (C组 ,2 0例 )即胃镜无胆汁反流现象 ,病理示慢性浅表性胃炎患者 ,分别抽血测空腹血清MTL和CCK含量。结果　A组血清CCK为 5 86pg/mL± 2 .78pg/mL ,较C组 3 80pg/mL± 1.10pg/mL有显著性升高 ,A组血清MTL为310 31pg/mL± 118 2 1pg/mL ,较C组 32 6 0 0pg/mL± 5 8 0 0pg/mL的降低无显著性差异 ,B组与C组相比CCK变化无显著性差异 ,MTL较C组有显著性降低 ,值为 2 2 8 30pg/mL± 72 2 0pg/mL。结论　DGR是胆道疾患的多见病理现象。胃运动功能障碍和幽门括约肌功能不全是病理性DGR的一个重要原因 ,胃十二指肠收缩不协调可导致DGR发生。MTL和CCK对胃排空和十二指肠运动起重要调节作用 ,胆囊切除术后和胆石症患者发生病理性DGR时存在CCK和MTL分泌不协调 ,调节紊乱的现象     

LC、胆总管探查及一期胆管缝合术治疗胆囊结石合并胆总管结石

目的观察腹腔镜胆囊切除术（Lc）、胆总管探查及一期胆管缝合术治疗胆囊结石合并胆总管结石的疗效。方法将85例胆囊结石合并胆总管结石患者随机分为观察组45例和对照组40例,对照组行LC、胆总管探查及T管引流术,观察组行Lc、胆总管探查及一期胆管缝合术。结果观察组术中出血量为（100±15）ml,手术时间为（136．5±25．0）min,住院时间为（10．5±2．0）d;对照组分别为（110±20）ml、（152．0±27．5）min、（13．5±2．5）d。两组比较,P均〈0．05。结论LC、胆总管探查及一期胆管缝合术治疗胆囊结石合并胆总管结石可有效减少术中出血量,缩短手术和住院时间。     

胆囊收缩素分泌及胰腺外分泌功能对消化不良的影响

脂肪刺激后，功能性消化不良（FD）患者胆囊收缩素（CCK）分泌增加，导致胃排空下降。一部分腹腔镜胆囊切除术（LC）的术后患者出现消化不良症状，其中十二指肠胃反流和血浆CCK水平升高是产生症状的重要原因。本研究以健康志愿者为对照，测定脂肪餐试验前后FD和LC术后患者CCK和胰腺外分泌功能（粪胰腺弹性蛋白酶-1）动态变化，旨在探讨其对消化不良的影响。     

应用改良Simpson法评价肝豆状核变性患者胆囊收缩功能

应用心脏左室容量计算法（改良Simpson法）评价肝豆状核变性患者胆囊收缩功能。方法选择肝豆状核变性患者54例和正常人60例,分别于空腹和脂餐试验后在胆囊长轴切面应用改良Simpson法测量胆囊容积,计算胆囊排空率。结果在空腹状态下,肝豆状核变性患者与正常对照组胆囊容积分别为（27.31±6.90）ml和（25.63±4.72）ml,差异无统计学意义（P〉0.05）;在高脂餐后,肝豆状核变性患者胆囊容积为（10.31±4.61）ml,明显大于正常对照组[（3.41±2.78）ml,P〈0.05];餐后肝豆状核变性患者胆囊排空率为（54.85±12.12）%,显著低于正常对照组[（73.48±7.60）%,P〈0.01]。结论采用改良Simpson法测量胆囊容积具有简单易行和重复性好的特点,有助于临床上评估肝豆状核变性患者的胆囊收缩功能。     

The effect of cholecystectomy on plasma cholecystokinin

OBJECTIVE: Gallbladder removal is associated with an increased incidence of gastroesophageal reflux, but the mechanism is unclear. Cholecystokinin (CCK) release, which causes gallbladder contraction, is inhibited by bile in the duodenum. This study investigates the effect of cholecystectomy on meal-stimulated CCK secretion. METHODS: Three groups of patients were studied. Group 1 (n = 15) were normal controls. Group 2 (n = 27) were patients with symptomatic gallstones. Group 3 (n = 25) were patients who had undergone cholecystectomy. Meal-stimulated CCK levels were measured by radioimmunoassay at defined time points for 60 min after a standard corn oil-based meal. RESULTS: Fasting CCK levels were similar in all three groups. In postcholecystectomy patients, meal-stimulated plasma CCK levels were significantly elevated compared with controls: median (range) integrated CCK values for 60 min were 116 (28-209) in controls, 123 (20-501) in gallstone patients, and 176 (63-502) after cholecystectomy. CONCLUSIONS: This study suggests that cholecystectomy causes an exaggerated meal-stimulated CCK response. Because CCK is known to relax the lower esophageal sphincter. these findings may help explain the increased incidence of gastroesophageal reflux seen after cholecystectomy.     

Effects of psychological stress on small intestinal motility and expression of cholecystokinin and vasoactive intestinal polypeptide in plasma and small intestine in mice

AIM: To investigate the effects of psychological stress on small intestinal motility and expression of cholecystokinin (CCK) and vasoactive intestinal polypeptide (VIP) in plasma and small intestine, and to explore the relationship between small intestinal motor disorders and gastrointestinal hormones under psychological stress. METHODS: Thirty-six mice were randomly divided into psychological stress group and control group. A mouse model with psychological stress was established by housing the mice with a hungry cat in separate layers of a two-layer cage. A semi-solid colored marker (carbon-ink) was used for monitoring small intestinal transit. CCK and VIP levels in plasma and small intestine in mice were measured by radioimmunoassay (RIA). RESULTS: Small intestinal transit was inhibited (52.18±19.15% vs70.19±17.79%, P<0.01) in mice after psychological stress, compared to the controls. Small intestinal CCK levels in psychological stress mice were significantly lower than those in the control group (0.75±0.53 μg/g vs1.98±1.17 μg/g, P<0.01), whereas plasma CCK concentrations were not different between the groups. VIP levels in small intestine were significantly higher in psychological stress mice than those in the control group (8.45±1.09 μg/g vs7.03±2.36 μg/g, P<0.01), while there was no significant difference in plasma VIP levels between the two groups. CONCLUSION: Psychological stress inhibits the small intestinal transit, probably by down-regulating CCK and up-regulating VIP expression in small intestine.     

三种外科疗法治疗老年胆囊结石并发肝外胆管结石病人的疗效比较

目的探讨3种外科疗法治疗老年胆囊结石并发肝外胆管结石病人的疗效与并发症。方法选取我院2016年7月至2019年6月收治的178例胆囊结石并发肝外胆管结石的老年病人作为研究对象,其中63例采用腹腔镜胆囊切除术联合腹腔镜胆总管探查术(LC+LCBDE),61例采用内镜逆行胰胆管造影联合腹腔镜胆囊切除术(ERCP+LC),54例采用胆囊切除术联合胆总管探查术(OC+OCBDE),对3种术式治疗前后病人的肝功能、手术情况及并发症发生情况进行比较分析。结果3组病人术后5 d AST、ALT以及总胆红素等肝功能指标均较术前明显降低(P<0.05);3组肝功能差异无统计学意义(P>0.05)。OC+OCBDE组手术时间较LC+LCBDE组和ERCP+LC组明显缩短(P<0.05),OC+OCBDE组术中出血量、肛门排气时间以及住院时间均较LC+LCBDE组和ERCP+LC组明显增加(P<0.05)。LC+LCBDE组、ERCP+LC组和OC+OCBDE组术后并发症的发生率分别为7.94%、21.31%和25.93%,组间比较差异具有统计学意义(P<0.05)。结论3种外科疗法治疗胆囊结石并发肝外胆管结石均可有效清除结石,改善肝功能,其中OC+OCBDE术式在缩短手术时间上具有一定的优势,LC+LCBDE术式发生术后并发症的风险最小。     

Do bile acids exert a negative feedback control of cholecystokinin release?

The influence of intraduodenal bile deficiency due to chronic bile duct obstruction and acute exogenous administration of bile acids on plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) was investigated. Fourteen patients with tumor-induced bile duct stenosis and five healthy volunteers were given a liquid test meal. Four of the patients had a simultaneous pancreatic duct stenosis. On another day 4 g chenodeoxycholic acid were administered concomitantly with the liquid test meal in six of the patients and all controls. Basal and meal-stimulated plasma CCK did not differ between patients and controls. A pancreatic duct stenosis, which was associated with diminished plasma PP concentrations, had no influence on plasma CCK release. Exogenous bile acids significantly reduced the postprandial CCK response in both groups. Bile-induced inhibition was significantly greater in patients than in controls (75 +/- 7% and 44 +/- 11%, respectively; p less than 0.05). It is concluded that intraduodenal bile is an important modulator of the postprandial secretory activity of the CCK cell. Although chronic intraduodenal bile acid reduction in tumor-induced biliary duct stenosis did not influence plasma CCK levels, a negative feedback control of plasma CCK by acute bile acid administration could be demonstrated.     

Role of endogenous bile on basal and postprandial CCK release in humans

The role of intraduodenal bile in regulation of plasma cholecystokinin (CCK) levels were investigated in patients with obstructive jaundice under external bile diversion and under physiological bile flow into the duodenum by internal bile drainage. Basal plasma CCK levels determined by a specific and sensitive bioassay in patients under external bile drainage (2.2±0.2 pmol/liter; mean±se) were significantly higher than those in control subjects (1.0±0.3 pmol/liter). In control subjects, the peak CCK response (6.2±0.7 pmol/liter) to a test meal was seen at 45 min, whereas that in patients under external bile drainage, it was seen at 20 min after a test meal (17.6±3.2 pmol/liter;P<0.01 vs controls). After peak response, plasma CCK levels in controls gradually decreased, but remained significantly elevated during a 3-hr observation period. In patients under bile diversion, the test meal caused a prompt plasma CCK peak, with a transient fall followed by a continuous rise until 180 min postprandially. In six patients, external bile diversion was changed to internal biliary drainage with a stent tube within two weeks to maintain physiological bile flow into the duodenum. Internal bile drainage normalized basal (0.9±0.2 pmol/liter) as well as meal-stimulated CCK release (peak value: 5.0±0.8 pmol/liter). These results demonstrate that endogenous bile exerts tonic inhibition on basal and postprandial plasma CCK levels in humans.Supported in part by a grant from the Japanese Ministry of Health and Welfare (Intractable Diseases of the Pancreas).     

ASSESSMENT OF BILE FLOW BY RADIOSCINTIGRAPHY IN PATIENTS WITH BILIARY-TYPE PAIN AFTER CHOLECYSTECTOMY

Scintigraphy of the biliary system using ^99mTc di-isopropyl iminodiacetic acid (DIDA) was performed in 65 subjects who had previously undergone cholecystectomy. Of the 65 subjects, 20 were free of pain and 45 had biliary-type pain both with (group I) and without (group II) features of sphincter of Oddi dysfunction. This dysfunction comprised dilatation of the bile duct, a transient rise in serum levels of liver enzymes after episodes of pain, or both abnormalities. After computer acquisition of images at intervals of 60 seconds for at least 90 minutes, time/activity curves were generated for five regions of interest: liver, common hepatic duct, common bile duct, duodenum, and background. The time at which counts in the common bile duct reached 50% of maximum (CBD T50) and the time of first entry of isotope into the duodenum (TD) were used to compare asymptomatic subjects with those with biliary-type pain. Patients in group I, but not those in group II, showed significant prolongation of CBD T50 (p < 0.002) and TD (p < 0.02) when compared to values in asymptomatic subjects. Six patients had a second scan at six to 12 months after endoscopic sphincterotomy and all showed a reduction in values for CBD T50 and TD. In patients with pain, a significant correlation was shown between bile duct diameter and CBD T50 (p < 0.01) and between bile duct diameter and TD (p < 0.02) but results from scintigraphy were independent of responses to morphine-neostigmine and motility in the sphincter of Oddi as assessed by endoscopic manometry. Some patients in group I had delayed excretion of DIDA into the duodenum and this correlated with the degree of dilatation of the biliary system.     

胰头癌和壶腹癌导致胆管梗阻的差异性

目的 确定胰头癌和壶腹癌在导致胆管梗阻方面是否存在差异.方法 分析患者住院后内镜逆行胰胆管造影之前的肝功检测指标与梗阻近段胆管直径的相关性.结果 胰头癌组血清丙氨酸转移酶和总胆红素水平高于壶腹癌组(P ＜0.05,P ＜0.01),壶腹癌组梗阻近段胆管扩张程度较胰头癌组明显(P ＜0.001).胰头癌组梗阻近段胆管直径与血清总胆红素之间存在明显相关性(P＜0.001),壶腹癌组两者之间无相关性(P＞0.05).结论 胰头癌与壶腹癌导致的胆管梗阻之间存在差异,壶腹癌组不存在黄疸越重胆管扩张越明显的特点.     

Factors affecting common bile duct diameter

BACKGROUND/AIMS: The purpose of the study was to see the effect of age, sex, body mass index, previous cholecystectomy, hepatomegaly and fasting status on the common bile duct diameter. METHODOLOGY: A series of 463 patients, 283 females and 180 males, with no hepatobiliary or pancreatic pathology were included in this study, the mean age was 45 +/- 16 years. Their age, sex, weight, height, fasting status and previous cholecystectomy was assessed and recorded by a physician prior to ultrasound examination. All patients were examined by real-time ultrasound to see if there was any pathology in the hepatobiliary and pancreatic area. Those with history of common bile duct exploration, endoscopic sphincterotomy or with previous history of cholecystectomy of less than 6 months and patients with common bile duct pathology were excluded from the study. The midportion of the common bile duct was taken as a fixed measurement for all patients and the size of the liver was also recorded. Analysis of variance as part of SPSS statistical package was used where common bile duct was considered a dependent variable, while sex, fasting status, hepatomegaly and previous cholecystectomy were considered to be independent variables, age and sex were considered as co-variants. RESULTS: The factors found to be significantly affecting the diameter of the common bile duct (P<0.05) were age, previous cholecystectomy and body mass index. CONCLUSIONS: If the CBD dilatation can not be explained by age, previous cholecystectomy and BMI, a pathology causing obstruction should be ruled out.     

Pancreaticobiliary maljunction: retrospective and nationwide survey in Japan

Pancreaticobiliary maljunction (PBM) is a congenital anomaly defined as a union of the pancreatic and biliary duct that is located outside the duodenal wall. The Japanese Study Group on Pancreaticobiliary Maljunction and the Committee for Registration enrolled and analyzed 1627 patients with PBM who had been diagnosed and treated from January 1, 1990 to December 31, 1999 at 141 hospitals throughout the country. There were 1239 patients with dilatation of the bile duct (group A) and 388 patients without dilatation (group B). The average age was 24 years in group A and 47 years in group B; the age was significantly higher in group B. The type of confluence between the terminal choledochus and the pancreatic duct has been classified into three types (type a, right-angle type; type b, acute-angle type; and type c, complex type). In group A, type a accounted for 57.9% and was significantly more frequent compared with the other types (type b, 32.4%; type c, 5.6%). In group B, type b accounted for 60.8%, being significantly more frequent compared with the other types (type a, 29.4%; type c, 7.2%). Subjective symptoms, preoperative complications (e.g., liver dysfunction and acute pancreatitis), pancreatic stone, and pancreatic duct morphological abnormality were significantly more frequent in group A. However, the amylase levels in the bile and gallbladder were significantly higher in group B, and the presence of gallstone and morphological abnormality of the gallbladder was significantly more frequent in group B. The occurrence rate of cancer in the biliary tract was 10.6% in group A and 37.9% in group B, being significantly higher in group B. In group A, cancer of the extrahepatic bile duct was seen in 33.6% and cancer of the gallbladder was seen in 64.9%, but gallbladder cancer was present significantly more frequently in the patients with diffuse or cylindrical dilatation, and bile duct cancer was present significantly more frequently in the patients with cystic dilatation. In group B, 93.2% of the patients had gallbladder cancer, and bile duct cancer was found in as few as 6.8%. Against this background Japanese surgeons regard cholecystectomy, resection of the extrahepatic bile duct, and hepaticojejunostomy as standard operations for PBM with dilatation of the bile duct. However, opinion on whether or not the bile duct should be removed in the treatment of PBM without dilatation of the bile duct has been divided among Japanese surgeons. A randomized controlled trial is necessary.     

腹腔镜胆囊切除术联合内镜下逆行胰胆管造影和十二指肠乳头括约肌切开术治疗胆囊结石合并肝外胆管结石患者疗效研究*

目的 探讨采用腹腔镜胆囊切除术(LC)、内镜下逆行胰胆管造影(ERCP)和十二指肠乳头括约肌切开术(EST)联合治疗胆囊结石合并肝外胆管结石患者的疗效。方法 2018年1月～2020年10月我院治疗的胆囊结石合并肝外胆管结石88例,在47例观察组采用LC联合ERCP和EST手术,在41例对照组采用开腹胆囊切除和胆总管探查取石治疗。采用视觉模拟评分法(VAS)评价术后疼痛程度。结果 两组结石一次性清除率比较无显著性差异(93.6%对95.1%,P>0.05);观察组术中出血量为(28.1±6.2)ml,显著少于对照组【(43.9±7.5)ml,P<0.05】,手术时间、术后禁食时间和住院时间分别为(105.7±25.5)min、(2.2±0.4)d和(7.6±1.0)d,显著短于对照组【分别为(130.2±26.7)min、(3.0±0.6)d和(12.7±1.3)d,P<0.05】;术后48 h和72 h VAS评分分别为(3.7±0.6)分和(2.5±0.5)分,均显著低于对照组【分别为(4.0±0.7)分和(2.9±0.5)分,P<0.05】;术后7 d,观察组血清ALT和AST水平分别为(46.1±5.6)U/L和(42.5±5.2)U/L,显著低于对照组【分别为(59.8±5.4)U/L和(64.7±5.1)U/L,P<0.05】,而血脂肪酶水平为(808.2±105.7)U/L,显著高于对照组【(721.9±103.0)U/L,P<0.05】;术后观察组并发症发生率为4.3%,显著低于对照组的14.1%(P<0.05)。结论 采用LC联合ERCP和EST治疗胆囊结石合并肝外胆管结石患者可促进术后恢复,改善肝功能,减少并发症的发生。