两种微创方法治疗胆囊结石合并胆总管结石的临床对比研究

The comparative analysis between two methods for minimally invasive surgery in the treatment of cholecystolithiasis and choledocholithiasis

目的评价腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查取石术(Laparoscopic common bile duct exploration,LCBDE)与内镜逆行胆管造影、括约肌切开(Endoscopic retrograde cholangiopancreaticography and endoscpic sphincterotomy,ERCP/EST)取石术联合LC治疗胆囊结石合并胆总管结石的对比研究。方法回顾性分析2012年1月至2013年7月247例胆囊结石合并胆总管结石患者的临床资料,其中124例行LC联合LCBDE,123例行ERCP/EST联合LC,对比胆总管内径、结石最大径、住院费用、住院时间、术后并发症的发生率、结石残余率等。结果两组胆总管结石数目、结石残余率、中转开腹率等方面统计学无明显差异。两组胆总管内径大小、胆总管结石最大径、手术失血量、术后早期并发症、住院费用、住院时间等有差异(P<0.05)。结论 LC联合LCBDE与ERCP/EST联合LC治疗胆囊结石并胆总管结石均是安全可靠的手术方式。应根据患者具体情况进行个体化治疗,腹腔镜胆总管探查取石总体上优于内镜ERCP/EST联合LC。

Objective To evaluate the effects of laparoscopic common bile duct exploration （LCBDE） and endoscopic retrograde cholangiopancreaticography and endoscopic sphincterotomy（ERCP/EST） combined with laparoscopic cholecystectomy（LC） in the treat-ment of cholecystolithiasis and choledocholithiasis. Methods The clinical data of patients suffering from cholecystolithiasis and choledocholithiasis from Jan.2012 to Jul.2013 were retrospectively analyzed. LC＋LCBDE was performed in 124 cases and ERCP/EST combined LC was performed in 123 cases. Parameters including common bile duct （CBD） diameter, stone size, hospitalization cost, hospital stay, postoperative complications, residual bile duct stone incidence were comparatively studied. Results There was no statistical difference in the number of stone , conversion rate and residual bile duct stones incidence. But there were significant dif-ference in CBD diameter, stone size, hospitalization cost, hospital stay, and early postoperative complication. Conclusion Both of LC＋LCBDE and ERCP/EST＋LC were safe and reliable to treat patients with cholecystolithiasis and choledocholithiasis. The treatment for patients must be individualized. LC＋LCBDE was better than ERCP/EST combined LC.