两种微创术式治疗胆囊结石合并胆总管结石的临床比较

Clinical comparison between two kinds of minimally invasive surgry in the treatment of cholecystolithiasis and choledocholithiasis

目的:对比研究腹腔镜下经胆囊管胆总管探查术(LTCBDE)与内镜逆行性胰胆管造影/内镜下括约肌切开取石术(ERCP/EST)在胆道外科中的应用。方法:回顾性分析2010-03-2015-08我院收治的胆囊结石合并胆总管结石的患者54例,依据手术方式的不同,将其分为LTCBDE+腹腔镜胆囊切除术(LC)组(n=21)和ERCP/EST+LC组(n=33),对比分析2组患者手术成功率、术后并发症、平均手术时间及平均住院时间等临床指标。结果:LTCBDE+LC组住院时间明显短于ERCP/EST+LC组[(9.74±4.50)d vs.(17.54±5.10)d,P<0.01)];LTCBDE+LC组术后医源性胰腺炎、术后残石并发症发生率明显低于ERCP/EST+LC组(0vs.12.12%,0vs.15.15%,P<0.01)。此外,由于ERCP/EST+LC组常规术后留置鼻胆引流管,患者主观不适感受明显加重,其术后患者疼痛评分明显高于LTCBDE+LC组[(7.10±2.70)分vs.(4.50±3.10)分,P<0.01)]。结论:相比ERCP/EST,LTCBDE是更有利于胆囊结石合并胆总管结石患者的微创治疗手段。

Objective：Comparision study on the treatment of cholecystolithiasis and choledocholithiasis between laparoscopic transcystic common bile duct exploration（LTCBDE）and endoscopic retrogrede cholangiopancreatography/endoscopic sphinctercotomy（ERCP/EST）in the application of the biliary tract surgery.Method：A retrospective analysis of 54 cases of patients with cholelithiasis and choledocholithiasis from Mar 2010 to Aug 2015 in our hospital.According to the different approach of surgry,the patients were divided into LTCBDE＋laparoscopic cholecystectomy（LC）group（n=21）and ERCP/EST＋LC group（n=33）.The success rate of surgery,postoperative complications,the average operation time and average length of hospital stay and other clinical indicators of two groups were analyzed.Result：LTCBDE＋LC group has an obviously shorter length of hospital stay than ERCP and EST＋LC group[（9.74±4.50）vs.（17.54±5.10）d,P〈0.01）];The iatrogenic postoperative pancreatitis,postoperative residual stone incidence of complications in LTCBDE＋LC group was lower than that in group of ERCP and EST＋LC（0vs.12.12%;0vs.15.15%,P〈0.01）.In addition,as a result of a routine indwelling ENBD tube in postoperative in ERCP/EST＋LC group,the patients＇ subjective unwell feeling is aggravating.And the postoperative pain score was significantly higher than that in LTCBDE＋LC group（7.10±2.70）vs（4.50±3.10）,P〈0.01）.Conclusion：Compared with ERCP/EST,LTCBDE is a more conducive treatment for cholecystolithiasis and choledocholithiasis.