逆行胰胆管造影联合内镜与腹腔镜联合胆道镜治疗单纯胆总管结石的临床效果

Analysis of clinical efficacy of endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterectomy versus laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration in the treatment of primary cholecystolithi

目的探讨内镜下逆行胰胆管造影术（ERCP）＋内镜乳头括约肌切开术（EST）与腹腔镜胆囊切除术（LC）＋腹腔镜胆总管探查术（LCBDE）治疗单纯胆总管结石的临床效果。方法回顾性分析2012年2月~2015年6月于江苏省盐城市第一人民医院行微创手术治疗的170例单纯胆总管结石患者的临床资料,按手术方式分为ERCP＋EST组（简称ERCP组,n=97）和LC＋LCBDE组（简称LCBDE组,n=73）。比较两组手术时间、术后禁食时间、术后住院时间、住院费用、取石成功率、中转开腹率、术后并发症发生率、结石复发率。结果 （1）两组均无围术期死亡。两组患者结石数量、最大结石直径、胆总管内径、手术取石成功率及中转开腹率比较,差异均无统计学意义（P〉0.05）。ERCP组手术时间、术后禁食时间、术后住院时间及住院费用均明显短或少于LCBDE组,差异有统计学意义（P〈0.05）。（2）LCBDE组患者总并发症发生率稍低于ERCP组,但差异无统计学意义（P〉0.05）。结论 ERCP与LCBDE治疗单纯胆总管结石均安全、有效,可根据患者情况个体化选择应用。

Objective To investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography（ERCP）plus endoscopic sphincterectomy（EST） and laparoscopic cholecystectomy（LC） plus laparoscopic common bile duct exploration（LCBDE） in the treatment of primary choledocholithiasis. Methods The clinical data of 170 patients with primary choledocholithiasis, who underwent minimally invasive surgical treatment in the First People＇s Hospital of Yancheng City from February 2012 to June 2015, were retrospectively analyzed. According to the operation methods, the patients were divided into the ERCP＋EST group（ ＂ERCP group＂ for short） with 97 cases and the LC＋LCBDE group（ ＂LCBDE group＂ for short） with 73 cases. The relevant clinical indexes including the operation time, fasting time after operation,duration of postoperative hospital stay, hospitalization charges and the clearance rate of calculus, conversion to open surgery ratio, postoperative complications and the recurrence of stones between the two groups of patients were compared.Results（1）No perioperative mortality occurred, and no significant differences were observed in terms of the number and maximum diameter of common bile duct stone, internal diameter of common bile duct, the clearance rate of calculus and conversion to open surgery ratio between the two groups（P〉0.05）. The operation time, postoperative fasting time and the length of postoperative hospital stay were significantly shorter in the ERCP group than those in the LCBDE group（P〈0.05）, and the total hospitalization cost in the former group was less than that in the latter group（P〈0.05）.（2）No significant difference was noted in overall incidence of complications between the two groups（P〉0.05）. Conclusion Both ERCP and LCBDE are safe and effective approaches for patients with primary cholecystolithiasis, and either of them can be selected according to the individual patient＇s condition.