同步或序贯腹腔镜内镜联合手术治疗胆囊合并胆总管结石的对比研究

Comparative Study on Synchronous or Sequential Laparoscopic Cholecystectomy Combined with Endoscopic Sphincterotomy for Cholecystocholedocholithiasis

目的探讨同步或序贯腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗胆囊合并胆总管结石的疗效。方法 2009年6月～2012年2月,85例胆囊结石合并胆总管结石分为同步手术组42例(LC联合术中EST)和序贯手术组43例(LC联合术前EST),比较2组手术时间、并发症发生率、手术成功率、术后住院时间、术后随访情况。结果 2组手术时间无明显差异[(115.3±64.8)min vs.(107.8±57.9)min,t=0.563,P=0.575]。与序贯手术组比较,同步手术组高淀粉酶血症发生率显著降低[2.4%(1/42)vs.18.6%(8/43),χ2=5.907,P=0.015],住院时间明显缩短[(5.9±1.7)d vs.(7.8±2.4)d,t=-4.203,P=0.000]。结论同步LC联合EST治疗胆囊结石合并胆总管结石术中选择性应用腹腔镜内镜会合或逆行胆管插管方案可降低并发症发生率,缩短住院时间。

Objective To compare the efficacy of synchronous or sequential laparoscopic cholecystectomy （LC） combined with endoscopic sphineterotomy （EST） for cholecystolithiasis complicated with common bile duct stones （CBDS）. Methods From June 2009 to February 2012, a total of 85 patients with cholecystolithiasis complicated with CBDS were divided into synchronous and sequential groups to received LC combined with EST. The operation time, rate of complications, success rate of surgery, postoperative hospital stay were compared between the two groups. Results No significant difference was observed in operation time between the two groups [ （ 115.3± 64.8） rain vs. （ 107.8 ± 57.9） rain, t = 0. 563, P = 0. 575 ]. However, synchronous group had significantly lower rate of hyperamylasemia and shorter hospital stay [ 2.4% （1/42） vs. 18.6% （8/43） , χ2 = 5. 907, P = 0. 015 ; and （5.9 ± 1.7） d vs. （7.8 ±2.4） d, t = - 4. 203, P = 0. 000 ] than the sequential group. Conclusions During synchronous LC combined with EST for cholecystolithiasis complicated with CBDS, selective RV or endoscopic retrograde cholangiopancreatography can decrease the rate of surgical complications.