腹腔镜胆囊切除术联合胆总管探查术与经内镜逆行胰胆管造影联合腹腔镜胆囊切除术的比较

One-stage Laparoscopic common bile duct incision and laparoscopic cholecystectomy verus two-stage laparoscopic cholecystectomy and laparoscopic cholecystectomy in treatment of gallstone and common bile duct stones

目的比较腹腔镜胆囊切除术联合胆总管探查术(LC+LCBDE)与经内镜逆行胰胆管造影联合腹腔镜胆囊切除术(ERCP+LC)的相关指标,分析其对患者术后生活的影响。方法随机选取因患胆总管结石合并胆囊结石在我院行LC+LCBDE以及行ERCP+LC的患者,观察其伴随疾病(高血压、糖尿病)、术前住院时间、腹部手术史、胆总管直径、术前白细胞、总胆红素、直接胆红素、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、总住院时间、住院总费用、手术出血量、胆囊大小、胆总管结石大小、残石率、术后1年胆总管结石复发率等指标。结果 LC+LCBDE组术前肝功能情况与ERCP+LC组比较,相对较差。ERCP+LC组的手术时间与LC+LCBDE组比较明显较短。LC+LCBDE组住院时间与ERCP+LC组比较,明显较短同时住院总费用较少。结论 LC+LCBDE组比ERCP+LC组拥有相对较低的住院费用和较短的住院时间,在疗效相同的前提下,LC+LCBDE可能是一种更为经济、实用的手术方式。

Objective Comparison of Laparoscopic common bile duct incision and laparoscopic cholecystectomy（ LCBDE ＋ LC） and two-stage laparoscopic cholecystectomy and laparoscopic cholecystectomy（ ERCP ＋ LC） related indicators,analysis of the impact of postoperative life for patients,to provide a reference for the choice of two kinds of surgery. Methods Randomly selected 77 patients with ERCP ＋LC,65 patients with LC ＋ LCBDE suffering from acute cholecystitis with gallbladder stones in our hospital underwent laparoscopic cholecystectomy. The sex,age,concomitant disease such as hypertension,diabetes,preoperative attack times,preoperative hospital time,abdominal operation history,common bile duct diameter,preoperative blood cell,total bilirubin,direct bilirubin,valley pyruvic transaminase,aspartate aminotransferase,duration of hospitalization,cost of hospitalization,bleeding in operation,gallbladder size,bile duct stones size,residual stone rate and common bile duct stone recurrence rate were observed. Results After statistics,it was found that the total bilirubin,direct bilirubin,alanine aminotransferase in the LC ＋LCBDE group were significantly higher than ERCP ＋ LC group. The operation time of ERCP ＋ LC group was significantly shorter than that of group LC ＋ LCBDE. The cost in the LC ＋ LCBDE group was less than the ERCP ＋ LC group. Conclusion LC ＋ LCBDE group has a lower cost of hospitalization and shorter hospital time than the ERCP ＋ LC group. LC ＋ LCBDE may be a more economical and practical operation method.