目的 探讨胆囊结石并发肝外胆管结石经腹腔镜胆囊切除术（LC）联合内窥镜逆行胰胆管造影术（ERCP）/内窥镜下括约肌切开术（EST）治疗的临床效果。方法 选取2020年1月—2023年6间就诊于南平市第一医院的86例胆囊结石合并肝外胆管结石患者,根据治疗方案不同分为对照组（n=40）和观察组（n=46）。对照组给予LC联合经腹腔镜胆总管切开取石术（LCBDE）治疗,观察组给予LC联合ERCP、EST在治疗,观察两组手术相关指标情况、血管紧张素水平、肝功能以及并发症发生情况。结果 观察组患者术中出血量少于对照组的（t=12.440,P<0.001）,观察组手术用时、肛门排气时间以及住院时间均短于对照组（均P<0.001）;观察组血管紧张素1-7（Ang1-7）、血管紧张素Ⅰ（AngⅠ）、血管紧张素Ⅱ（AngⅡ）水平低于对照组,组间比较差异均无统计学意义（均P>0.05）;观察组总胆红素（TBIL）、谷氨酸转氨酶（ALT）水平低于对照组水平,组间比较差异无统计学意义（均P>0.05）;观察组无患者发生胆漏、结石残留,对照组胆漏、结石残留发生率分别为5.00%、2.50 %,组间对比差异均无统计学意义（均P>0.05）,观察组出血、胆道感染生率分别为4.35 %、2.17 %低于对照组10.00%、5.00 %,组间对比差异均无统计学意义（均P>0.05。结论 LC联合ERCP/EST治疗胆囊结石合并肝外胆管结石可以减少术中出血,缩短手术用时和住院时间。

Objective This study aims to investigate the clinical efficacy of laparoscopic cholecystectomy（LC）combined with endoscopic retrograde cholangiopancreatography（ERCP）or endoscopic sphincterotomy（EST）in the treatment of gallbladder stones complicated by extrahepatic bile duct stones．Methods A total of 86 patients with gallbladder stones and extrahepatic bile duct stones treated at the First Hospital of Nanping from January 2020 to June 2023 were selected．According to different treatment regimens,they were divided into a control group（n=40）and an observation group（n=46）．The control group received LC combined with laparoscopic common bile duct exploration（LCBDE）,while the observation group received LC combined with ERCP and EST．Surgical-related indicators,angiotensin levels,liver function,and complications were observed in both groups．Results The observation group had less intraoperative bleeding than the control group（t=12.440,P<0.001）．The observation group had a shorter operation time,postoperative anal exhaust time,and hospital stay than the control group（all P<0.001）．The levels of angiotensin 1-7（Ang1-7）,angiotensin I（AngⅠ）,and angiotensin II（AngⅡ）in the observation group were lower than those in the control group,with no statistically significant differences between the groups（all P>0.05）．Total bilirubin（TBIL）and alanine aminotransferase（ALT）levels in the observation group were comparable to those in the control group（all P>0.05）．No patients in the observation group experienced bile leakage or residual stones,while the incidence rates in the control group were 5.00% and 2.50%,respectively,with no statistically significant differences between the groups（all P>0.05）．The observation group had lower rates of bleeding and biliary tract infection at 4.35% and 2.17%,respectively,compared to the control group at 10.00% and 5.00%,with no statistically significant differences between the groups（all P>0.05）．Conclusions LC combined with ERCP/EST in the treatment of gallbladder stones complicated by extrahepatic bile duct stones can reduce intraoperative bleeding,shorten operation time,and decrease hospital stay．

目的 探讨标准化沟通（SBAR）模式交接班联合护理质量指标管理在胆管结石患者中的应用效果及护理质量、不良事件及并发症影响。方法 选取天津市人民医院2021年1月—2022年12月收治的80例胆管结石患者,应用抽签法分为观察组与对照组,每组各40例。所有患者均采取手术治疗,其中对照组患者实施常规护理,观察组患者在对照组基础上增加SBAR沟通模式交接班联合护理质量指标管理。对比两组患者的护理质量、护理不良事件发生率、护理满意度及术后并发症发生率。结果 观察组基础护理、护理态度、护理责任心、风险识别能力、风险防范能力护理质量评分高于对照组（P<0.05）;两组注射、口服给药差错、换药、抽血差错、病例书写错误以及执行医嘱不及时等护理不良事件发生率对比差异无统计学意义（P>0.05）,观察组患者护理满意度高于对照组（P<0.05）;观察组患者压疮、感染、静脉血栓等并发症发生率均低于对照组（P<0.05）。结论 SBAR沟通模式交接班联合护理质量指标管理针对胆管结石患者应用效果显著,可改善临床护理质量,同时患者护理满意度较高,进一步降低患者术后并发症发生率。

Objective To investigate the application effect of SBAR communication mode shift combined with the management of care quality indicators on patients with bile duct stones and their influence on postoperative complications. Methods Eighty patients with bile duct stones admitted to our hospital from January 2021 to December 2022 were selected,and divided into observation group and control group by drawing lots,40 cases each．All the patients were treated by surgery,and the control group patients received routine care,and the observation group patients added the SBAR communication mode．The quality of care,incidence of adverse events,satisfaction with care and incidence of postoperative complications of the two groups were compared. Results The quality of care values of basic care,nursing care,nursing responsibility,risk identification and risk prevention in the observation group were significantly higher than in the control group（P<0.05）．There was no difference in the incidence of nursing side effects such as injection and oral administration errors,dressing changes,blood sampling errors,case clerk errors and delayed execution of medical orders between the two groups（P>0.05）．Patient satisfaction in the observation group was significantly higher than that in the control group（P<0.05）．The incidence of complications such as pressure ulcers,infections and venous thrombosis in the observation group was significantly lower than that in the control group（P<0.05）. Conclusions SBAR communication mode and combined nursing quality index management for patients with bile duct stones,which can improve the quality of clinical nursing and patient nursing satisfaction,and further reduce the incidence of postoperative complications in patients．