胆囊结石合并胆总管结石的外科微创治疗

Minimal Invasive Therapy for Patients with Choledocholithiasis and Gallbladder Stone

目的探讨胆囊结石合并胆总管结石的外科微创治疗方式的选择,对比研究内镜下乳头括约肌切开术+腹腔镜胆囊切除(endoscopic sphincterotomy+laparoscopic cholecystectomy,EST+LC)和腹腔镜下胆总管探查(laparoscopic explorationof common bile duct/laparoscopic transcystic exploration of common bile duct,LCBDE/LTCBDE)。方法回顾分析2009年8月～2011年9月手术治疗胆囊结石合并胆总管结石56例的临床资料,EST+LC组26例,LCBDE/LTCBDE组30例,2组年龄、性别、体重指数、丙氨酸转氨酶、总胆红素、胆总管直径和ASA评分差异无显著性。对比2种微创治疗方式的住院时间、住院费用和治疗效果。结果 2组住院时间差异无显著性[(9.0±3.5)d vs.(10.1±3.4)d,t=-1.191,P=0.256]。EST+LC组住院费用高于LCBDE/LTCBDE组[(20 017.5±4748.8)元vs.(16 249.5±3366.1)元,t=3.459,P=0.001]。2组并发症和中转开腹的发生率差异无显著性[15.4%(4/26)vs.13.3%(4/30),χ2=0.000,P=1.000]。结论 EST+LC和LCBDE/LTCBDE是胆囊结石合并胆总管结石有效、安全的治疗方式,LCBDE/LTCBDE住院费用明显降低,两者之间并发症并无明显差异。

Objective To study the minimal invasive therapy for patients with choledocholithiasis and gallbladder stone, and compare the efficacy of endoscopic sphincterotomy ＋ laparoscopic cholecystectomy （ EST ＋ LC） and laparoscopic exploration of common bile duct/laparoscopic transcystic exploration of common bile duct（LCBDE/LTCBDE）. Methods From August 2009 to September 2011, 56 patients with choledocholithiasis and gallbladder stone received minimal invasive therapy in our hospital, including EST ＋ LC in 26 patients, and LCBDE/LTCBDE in 30 patients. The age, gender, body mass index （BMI） , levels of ALT and total bilirubin, diameter of the common bile duct, and ASA score were not significantly different. We compared the hospital stay and cost and therapeutic outcomes between the two approaches. Results No significant difference was observed in hospital stay and rates of surgical complications and conversion to open surgery between the two approaches [ （9.0 ± 3.5 ） d vs. （ 10.1 ± 3.4 ） d, t = - 1. 191, P=0.256; 15.4%（4/26） vs. 13.3% （4/30）,x2 =0.000, P=1.000]. However, the hospital cost of the EST＋LC group was significantly higher than that of the LCBDE/LTCBDE group [ （20 017.5 ±4748.8 ） RMB vs. （ 16 249.5± 3366.1 ） RMB, t = 3. 459, P = 0. 001 ]. Conclusions Both EST ＋ LC and LCBDE/LTCBDE are safe and effective approaches for patients with choledocholithiasis and gallbladder stone. The rates of complications of the two approaches are similar, but the average cost for LCBDE/LTCBDE is significantly less than that for EST ＋ LC.