腹腔镜胆囊切除联合不同胆总管探查方法治疗胆总管结石

A study of choledocholithiasis in patients undergoing laparoscopic cholecystectomy combined with different laparoscopic common bile duct exploration

目的比较腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)联合经胆囊管胆道探查术(Trans-cystic duct common bile duct exploration,TCD-CBDE)与LC联合胆总管切开探查术(choledochotomy common bile duct exploration,C-CBDE)用于治疗胆囊结石合并胆总管结石患者的临床效果。方法采用单中心回顾性横断面研究方法,收集209例胆囊结石合并胆总管结石患者的临床资料,完成随访,使用t检验、2检验或Fisher确切概率法比较两种手术方式患者的平均手术时间、中转开腹率、术后住院时间、结石清除率、术后并发症发生率、术后胆漏发生率以及结石复发率等。结果 209例患者中,131例(62.68%)行LC+TCD-CBDE,78例(37.32%)行LC+C-CBDE。LC+C-CBDE组患者平均手术时间、中转开腹率、术后住院时间、术后并发症发生率、术后胆漏发生率均高于LC+TCD-CBDE组患者(P<0.05);结石清除率、术后结石复发率两组比较,差异无统计学意义(P>0.05)。结论在把握适应证及禁忌症的前提下,LC联合不同LCBDE方法对胆囊结石合并胆总管结石患者的治疗均是安全有效的。

Objective To compare the clinical effect of laparoscopic cholecystectomy（LC）combined with transcystic duct common bile duct exploration（TCD-CBDE）and ch oledocho-tomy common bile duct exploration（C-CBDE）in the treatment of cholecystolithiasis with choledocholithiasis.Methods The clinical data of 209 patients with cholecystolithiasis combind with choledocholithiasis underwent surgical treatment were reviewed retrospective-ly and followed up.The mean operative time,rate of conversion to open surgery,length of postoperative hospital stay,complete ductal clearance rate,incidence of after surgery,biliary leakage rate and recurrent stone rate were compared between two groups utilizing t test,chi-square test or Fisher exact test.Results Of 209 patients,131（62.68%）patients were managed by LC＋TCD-CBDE and 78（37.32%）patients underwent LC＋C-CBDE.The mean operative time,the rate of conversion to open surgery,length of postoperative hospital stay,the incidence of complication after surgery and the biliary leakage rate in LC＋C-CBDE group were significantly more than those in LC＋TCD-CBDE group（all P〈0.05）.There was no significant difference in the complete ductal clearance rate and the recurrent stone rate between two groups（P〉0.05）.Conclusion LC combined different approach of LCBDE is safe and effective when taking the indication and contraindication for TCD-CBDE and C-CBDE strictly.