腹腔镜胆道镜治疗胆囊结石合并胆总管结石两种术式的疗效比较

Comparison of two laparoscopic choledochoscopy for gallbladder stones and common bile duct stone

目的对比腹腔镜胆囊切除+经胆囊管胆道探查术(LC+LTCBDE)与腹腔镜胆囊切除术+胆总管切开探查+T管引流术(LC+LCHTD)两组微创手术方式治疗胆囊结石合并胆总管结石的临床疗效。方法 130例胆囊结石合并胆总管结石患者,其中70例行LC+LTCBDE,60例行LC+LCHTD。比较两组患者手术时间、术后住院时间、住院费用、术后恢复正常生活时间和并发症情况(胆漏、出血、胆管狭窄,胆管残余结石等)。结果 LC+LTCBDE组的手术时间、术后住院时间、住院费用、术后恢复正常生活时间均低于LC+LCHTD组,差异有统计学意义(P<0.05)。两组术后并发症比较,差异无统计学意义(P>0.05)。结论 LC+LTCBDE可作为胆囊结石合并胆总管结石的首选治疗,难以经胆囊管胆道探查时,LC+LCHTD仍为明智选择。

Objective To compare the effects of two minimally invasive surgeries for treating gallbladder stones and bile duct stones. Methods The clinical data of 130 patients with both gallbladder stones and common bile duct stones in our hospital from Dec. 2012 to Dec. 2014 were analyzed retrospec- tively, including 70 cases with laparoscopic cholecystectomy plus laparoscopic common bile duct explora- tion by transcystic approach （ LC ＋ LTCBDE group） and 60 cases with laparoscopic cholecystectomy plus laparoscopic choledocholithotomy and T-tube drainage （ LC ＋ LCHTD group）. Operation situation （ opera- tion time, postoperative hospital stay, hospital costs, and recovery time） and complications （ bile leakage, bleeding,bile duct stricture, and residual stones） were compared between the groups. Results The operation time, hospital stay, hospital costs, and recovery time in the LC ＋ LCBDE group were lower than those of the LC ＋ LCHTD group （ P 〈 0.05 ）. There were no significant differences in postoperative complica- tions between the groups （ P 〉 0. 05 ）. Conclusion For gallstones and common bile duct stones, LC ＋ LCBDE can be the priority choice. If it＇s difficult to explore the cystic duct, LC ＋ LCHTD would still be a sensible choice.