两种微创治疗方案治疗急性结石性胆管炎的临床对照研究

Comparison between Two Approaches for Minimally Invasive Surgery for Acute Calculus Cholangitis

目的比较腹腔镜胆囊切除术联合胆总管探查术(LC联合LCBDE)与内镜乳头切开取石联合腹腔镜胆囊切除术(EST联合LC)在急性结石性胆管炎治疗中的临床疗效。方法回顾性分析2007年3月～2011年9月126例轻度或中度急性结石性胆管炎的临床资料,其中LC联合LCBDE 57例,EST联合LC 69例。对结石清除率、术后并发症、中转开腹率及单次治疗成功率等指标进行比较。结果 2组结石清除率、并发症发生率、中转开腹率差异无显著性,而单次治疗成功率LC联合LCBDE组高于EST联合LC组[89.5%(51/57)vs.75.4%(52/69),χ2=4.166,P=0.041]。所有病例随访0.5～3年,平均1.8年,均未出现腹痛、发热及黄疸等症状,B超未见结石复发。结论 LC联合LCBDE和EST联合LC都是治疗急性结石性胆管炎安全有效的方法,而在减少治疗次数、减轻病人痛苦方面,LC联合LCBDE更有优势。

Objective To compare the efficiency of laparoscopic cholecystectomy combined with common bile duct exploration （LCBDE ＋ LC） and endoscopic sphincterotomy followed by laparoscopic cholecystectomy （EST ＋ LC） for acute calculus cholangitis. Methods A retrospective analysis involved totally 126 patients with mild or moderate acute calculus cholangitis, who received minimally invasive surgery in our hospital from March 2007 to September 2011. Among the cases, LCBDE ＋ LC was performed on 57 cases, and EST ＋ LC in the other 69. The stone clearance rate, postoperative complications, rate of conversion to open surgery, and success rate of single-session operation were compared between the two groups. Results No significant difference was detected in the stone clearance rate, postoperative complications, and rate of conversion to open surgery between the two groups （ P 〉 O. 05 ）. However, LC ＋ LCBDE group showed a significantly higher success rate of single-session operation than the EST ＋ LC group [ 89.5% （51/57） vs. 75.4% （52/69） , X2 =4. 166, P =0. 041 ]. In both the groups, all the patients received a follow-up for a mean of 1.8 years （ranged from 6 months to 3 years） , during which no abdominal pain, fever, or jaundice were detected, and re-examination by B- ultrasonography showed no recurrent stones. Conclusion Both LC ＋ LCBDE and EST ＋ LC are effective for acute calculus cholangitis, however, with LC ＋ LCBDE, the patients undergo less sessions of operation, and thus suffer less from the surgical procedures.