LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石的梗阻性黄疸患者的临床对照研究

Clinical Comparative Analysis of LC+LCBDE and ERCP/EST+LC for Cholecystolithiasis with Choledocholithiasis Patients with Obstructive Jaundice

目的探讨腹腔镜胆囊切除术(LC)联合腹腔镜胆总管探查取石术(LCBDE)与内镜下逆行胰胆管造影(ERCP)及乳头括约肌切开取石术(EST)联合LC治疗胆囊结石合并胆总管结石的梗阻性黄疸患者的疗效及安全性。方法回顾性分析我院2011年1月至2012年6月期间分别采用LC+LCBDE(LC+LCBDE组,n=48)及ERCP/EST+LC(ERCP/EST+LC组,n=76)治疗的胆囊结石合并胆总管结石的梗阻性黄疸患者的临床资料,比较分析2组患者的临床治疗情况。结果①2组患者的一般临床资料如年龄、性别、术前总胆红素和丙氨酸转氨酶、结石数量、最大结石直径及胆总管内径比较,差异均无统计学意义(P>0.05),具有可比性。②2组均无围手术期死亡病例。2组患者的取石成功率、中转开腹率及并发症发生率比较差异均无统计学意义(P>0.05),但是LC+LCBDE组手术时间及术后住院时间均明显短于ERCP/EST+LC组(P<0.05),手术费用及住院费用也少于ERCP/EST+LC组(P<0.05)。结论 ERCP/EST+LC与LC+LCBDE治疗胆囊结石合并胆总管结石的梗阻性黄疸患者同样安全、有效。但LC+LCBDE成本效益更高,有利于患者恢复,尤其是当胆总管直径大于1.0 cm或多发结石,LC+LCBDE是最佳选择。总之,应根据患者实际病情及医院条件,个体化选择最适合患者的微创治疗方式。

Objective To discuss the therapeutic effect and safety of laparoscopic cholecystectomy plus laparoscopic common bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy plus LC （ERCP/EST ＋ LC） for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. Methods The clinical data of cholecystolithiasis with choledocholithiasis patients with obstructive jaundice from January 2011 to June 2012 were analyzed retrospectively. During this period, 48 patients were treated by LC＋ LCBDE （LC＋ LCBDE group）, and 76 patients by ERCP/EST＋LC （ERCP/EST＋LC group）. Results ① There were no statistical significances in the age, gender, preoperative total bilirubin, alanine aminotransferase, number and maximum diameter of common bile duct stone, and internal diameter of common bile duct in two groups （P〉0. 05）. ② No perioperative mortality occurred and no significant differences ,uere observed in terms of stone clearance from the common bi｜e duct, postoperative morbidity, and conversion to open surgery in two groups （P〉0. 05）. However, the operative time and postoperative hospital stay in the LC ＋ LCBDE group were shorter than those in the ERCP/EST ＋ LC group （P〈 0. 05）. In addition, the costs of surgical procedure and hospitalization charges in the LC ＋ LCBDE group were less than those in the ERCP/ EST ＋ LC group （P〈 0.05）. Conclusions Both LC ＋ LCBDE and ERCP/EST ＋ LC are safe and effective therapies for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. However, LC＋ LCBDE is better for patients＇ recovery and cost effective. Especially for patients with common bile duct 〉 1.0 cm in diameter or with multiple common bile duct stones, LC＋LCBDE is the best choice. To sum up, the choice of minimally invasive treatment must be individualized according to the patient＇s condition and the availability of local resources.