ERCP+LC和LC+LCBDE治疗胆囊结石合并胆总管结石的效果比较

Retrospective study on the clinical effect of the treatment of ERCP + LC and LC + LCBDE on cholecystolithiasis and choledocholithiasis

目的比较腹腔镜胆囊切除(LC)联合胆总管探查取石术(LCBDE)和十二指肠镜逆行胰胆管造影术(ERCP)联合LC治疗胆总管结石的疗效及安全性。方法回顾性分析2013年2月到2017年4月期间在我院收治的胆囊结石合并胆总管结石患者临床资料,其中ERCP+LC组81例与LC+LCBDE组85例,比较两组病例手术总时间、手术成功率、中转开腹率、手术后疼痛、住院费用、并发症等指标的差异。结果 ERCP+LC组术中出血量、手术总时间、术后放置腹腔引流管例数、腹痛患者例数、术后排气时间、恢复活动时间均少于LC+LCBDE组(P<0.05)。而在住院费用方面,LC+LCBDE组较低(P<0.05)。结论腹腔镜联合十二指肠镜(ERCP+LC)与腹腔镜联合胆道镜(LC+LCBDE)这两种微创术式均是处理胆囊结石合并胆总管结石的安全、有效的方式,具体术式应根据患者个体情况及医院自身技术和设备条件合理选择。

Objective To compare the clinical effects and safety of ERCP ＋ LC and LC ＋ LCBDE in thetreatment of gallbladder stones with common bile duct stones. Methods Clinical data of 166 cases of gallbladderstones with common bile duct stones treated with ERCP ＋ LC（n = 81）and LC＋LCBDE（n = 85）from Feb. 20 l3 toApr. 2017 were retrospectively analyzed. The differences in total time,success rate,conversion rate,postoperativepain,hospitalization expenses and complications were recorded and compared between cases of the two groups.Results The intraoperative blood loss,total operative time and postoperative abdominal drainage tube number inERCP ＋ LC group were less than those in group LC ＋ LCBDE（P〈0.05）. The number of patients with abdominalpain after treatment in ERCP ＋ LC group was less than that in LC ＋ LCBDE group（P〈0.05）. The postoperativeexhaust time and recovery time in ERCP ＋ LC group were less than those in group LC ＋ LCBDE,there was signifi-cant difference between two groups（P〈0.05）. The LC ＋ LCBDE group was lower than the ERCP＋LC group in thecost of hospitalization（P〈0.05）. Conchusion Both ERCP ＋ LC and LC ＋ LCBDE are safe and effective for thetreatment of gallbladder stones with common bile duct stones. Both of which can be selected depending on the indi-vidual condition of the patient and the skill and equipment conditions.