ERCP与腹腔镜胆总管探查治疗胆囊结石合并胆总管结石的比较

The comparision of ERCP and laparoscopic common bile duct exploration to treat gallbladder stones combined with common bile duct stones

目的比较ERCP与腹腔镜胆总管探查(LCBDE)治疗胆囊结石合并胆总管结石的优、缺点。方法回顾分析2010年4月至2015年4月5年间诊治的197例胆囊结石合并胆总管结石患者。结果 ERCP组(99例)中有6例患者手术失败,32例合并胰腺炎,1例出现十二指肠壁穿孔。3例患者术后出现胆总管结石复发。LCBDE组(98例)中无手术失败,8例放置T管,无胆总管结石复发,无严重并发症。LCBDE组术后平均住院时间和平均住院费用均低于ERCP组[(5±2)d vs(3±1)d,(2.23±0.85)万元vs(1.73±0.43)万元]。结论 ERCP+EST和LCBDE对于胆囊结石合并胆总管结石都是行之有效的处理方法,对于大多数患者应首选LCBDE,对于特殊患者可选择ERCP+EST+LC方案。

Objective To compare the advantages and disadvantages of ERCP and laparoscopic common bile duct exploration for the treatment of gallbladder stones combined with common bile duct stones.Methods The therapeutic results of 197 cases who underwent ERCP or LCBDE were reviewed retrospectively to find out the advantages and disadvantages of the two operations. Results There are6 cases operation failure,32 cases acute pancreaitis,1 case duodenum perforation and 3 cases common bile duct stones recurrence in the ERCP group（ 99 cases）. There are no operation failure,8 cases with T-tube drainage,no serious complications and no bile duct stones recurrence in the LCBDE group（ 98 cases）. The hospital stay time and hospital costs of LCBDE group is lower than the ERCP group[（ 5 ± 2） d vs（ 3 ± 1） d,（ 2. 23 ± 0. 85） Million yuan vs（ 1. 73 ± 0. 43） Million yuan]. Conclusions The ERCP and LCBDE are effective methods for the treatment of Gallbladder stones combined with common bile duct stones. For most patients,the LCBDE is the first choice method,and for some special patient,ERCP is a good choice.