一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较

One-staged laparoscopic cholecystectomy and common bile duct exploration versus two-staged endoscopic stone extraction followed by laparoscopic cholecystectomy for concomitant cholecystolithiasis and choledocholithiasis

目的:比较一期腹腔镜胆囊切除(LC)联合胆总管探查取石(LCBDE)与分期内镜取石(ERCP)和LC治疗胆囊结石合并胆总管结石的临床效果。方法:回顾性分析2013年1月—2014年6月在西安交通大学第一附属医院行微创治疗的112例胆囊结石合并胆总管结石患者资料,其中52例行一期LC+LCBDE(LCBDE组),60例行ERCP后24 h或择期行LC(ERCP组),比较两组相关临床指标。结果:除LCBDE组平均年龄小于ERCP组外(42.4岁vs.57.4岁,P<0.05),两组其余一般资料均具有可比性。两组均无死亡病例,手术成功率(94.3%vs.98.4%)、总并发症发生率(8.2%vs.10.1%)、结石残余发生率(2.0%vs.1.7%)等差异均无统计学意义(P>0.05);ERCP组术后高淀粉酶血症发生率明显高于LCBDE组(16.9%vs.4.1%,P<0.05),但均为单纯性淀粉酶升高;与ERCP组比较,LCBDE组术后住院时间更短(4.9 d vs.6.3 d),总住院费用减少(21 685.9元vs.30 354.3元),但LCBDE组手术时间明显延长(117.1 min vs.97.4 min)(均P<0.05)。结论:一期LC+LCBDE或分期ERCP+LC治疗胆囊结石合并胆总管结石均安全、有效,可根据患者情况选择应用。

Objective： To compare the clinical ei cacy of single-staged laparoscopic cholecystectomy（LC） and common bile duct exploration（LCBDE） with two-staged endoscopic retrograde cholangiopancreatography（ERCP） followed by LC in treatment of concomitant gallbladder stones and common bile duct stones.Methods： h e clinical data of 112 patients with concomitant gallbladder stones and common bile duct stones, who underwent minimally invasive surgical treatment in the First Affiliated Hospital of Xian Jiaotong University from January 2013 to June 2014, were retrospectively analyzed. Of the patients, 52 cases received single-staged LC plus LCBDE（LCBDE group）, and 60 cases underwent two-staged ERCP followed by LC 24 h later or elective LC（ERCP group）, and the main clinical variables between the two groups of patients were compared.Results： Except for the average age in LCBDE group was younger than that in ERCP group（42.4 years vs. 57.4 years, P〈0.05）, all the other data between the two groups were comparable. No death occurred in either group, and no significant difference was noted in surgical success rate（94.3% vs. 98.4%）, overall incidence of complications（8.2% vs. 10.1%） and residual stone rate（2.0% vs. 1.7%） between the two groups（all P〉0.05）. h e incidence of hyperamylasemia was signii cantly higher in ERCP group than that in LCBDE group（16.9%vs. 4.1%, P〈0.05）, but all were transient amylase elevations. In LCBDE group compared with ERCP group, the length of postoperative hospital stay was shorter（4.9 d vs. 6.3 d） and total hospitalization cost was reduced（21 685.9 yuan vs. 30 354.3 yuan）, but the operative time was prolonged（117.1 min vs. 97.4 min）（all P〈0.05）.Conclusion： Both single-staged LC plus LCBDE and two-staged ERCP plus LC are safe and effective in treatment of concomitant gallbladder stones and common bile duct stones, and either of them can be selected according to the individual patient’s condition.