合并胆囊结石的胆总管结石内镜取石术后是否保留胆囊的病例对照研究

Case-control study on necessity of cholecystectomy for patients with bile duct stones combined with gallbladder stones after clearance of stones

目的探讨无胆囊切除绝对手术指征的胆总管结石（CBDS）合并胆囊结石（GS）患者，在行经内镜逆行胰胆管造影术（ERCP）取石后是否需常规切除胆囊。方法收集2012年1月至2014年12月杭州市第一人民医院无胆囊切除绝对手术指征、年龄≤70岁的CBDS合并GS患者于ERCP取石后的临床资料，按是否保留胆囊分为胆囊切除组和胆囊保留组，对比两组一次性住院时长、胆道事件发生率及术后并发症情况。结果研究中总共纳入128例患者，其中胆囊切除组64例，胆囊保留组64例。在平均（24。031＋9．170）个月的随访期间，胆囊切除组与胆囊保留组胆道事件发生率分别为7．8％（5／64）和10．9％（7／64）（P=0．544），其中胆管炎发生率分别为7．8％（5／64）和4．7％（3／64）（P=0．465），胰腺炎发生率为0（0／64）和1．6％（1／64）（P=0．315），胆总管结石复发率为7．8％（5／64）和7．8％（5／64）（P=1），无胆囊炎复发病例；胆囊切除组和胆囊保留组ERCP术后相关并发症发生率分别为23．4％（15／64）和12．5％（8／64）（P=0．107）；胆囊切除组的胆囊切除术后并发症发生率为6．3％（4／64），其中3例为术后感染、1例为肠梗阻；胆囊切除组和胆囊保留组的住院时间分别为（14．313~6．312）d和（5．906＋4．614）d（P〈0．001）；住院费用分别为（4．5196±1．2518）万元和（2．2160±1．1755）万元（P〈0．001）。结论保留胆囊可明显减少住院天数及住院费用，避免胆囊切除术后综合征及手术相关并发症。对不存在胆囊切除的绝对手术指征CBDS合并GS患者在ERCP取石后可推荐保留胆囊。

Objective To discuss necessity of cholecystectomy for patients with stones in their bile ducts and gallbladders in the absence of absolute operation indications of cholecystectomy after clearance of bile duct stones with ERCP. Methods Data of less than 70-year-old patients with stones in their bile ducts and gallbladders but without absolute operation indications of cholecystectomy admitted to the First People＇s Hospital of Hangzhou from January 2012 to December 2014 were retrospectively analyzed. Patients were divided into cholecystectomy group and gallbladders in situ group after bile duct stones removal with ERCP. The hospitalization time, recurrent biliary events, complications of operation were compared between two groups. Results A total of 128 patients were included and followed up for （24. 031~9. 170） months with 64 cases in conservative group and 64 cases in cholecystectomy group. Incidence of recurrent biliary events in the cholecystectomy group and conservative group were 7. 8% （ 5/64 ） and I0. 9% （ 7/64 ） （ P = 0. 544 ）. Among cases of recurrent biliary events, incidences of eholangitis in the two groups were 7. 8% （5/64） and 4. 7% （ 3/64 ） respectively （ P = 0. 465 ）, incidences of pancreatitis were 0 （ 0/64 ） and 1.6% （ 1/64 ） respectively （P= 0. 315 ）, incidences of common bile duct stones were 7. 8% （5/64） and 7. 8% （5/64） respectively （P = l ）. No recurrent cholecystitis occurred. There were no differences in ERCP-related complications between the cholecystectomy group [ 23.4% （15/64） ] and the conservative group [ 12. 5% （8/64） ] （P = 0. 107）. But 4 patients （6. 3%） in cholecystectomy group had LC-related complications during the follow-up period, 3 cases of infection and 1 ileus. The hospital stay in conservative group was shorter than that in cholecystectomy group （5. 906＋4. 614 days VS 14. 313＋6. 312 days, P〈0. 001）. The hospitalization expenses in two groups were （45 196＋ 12 518） yuan and （ 22 160＋ 11 755 ） yuan （ P 〈 0. 001 ）. Conehtsion Conservative methods yield to shorter hospitalization and lower expenses without cholecystectomy-related complications. Conservative management for gallbladder stones after ERCP for biliary duet stones is recommended for patients who had no absolute operation indications of cholecysteetomy.