不同术式治疗胆囊合并胆总管结石的疗效对比

Comparison of clinical efficacy of laparoscopic cholecystectomy combined with LCBDE and ERCP/EST treatment of cholecystolithiasis with choledocholithiasis

目的对比评价腹腔镜胆囊切除术(LC)联合腹腔镜胆总管切开取石术(LCBDE)及内镜逆行胰胆管造影、括约肌切开取石术(ERCP/EST)治疗胆囊合并胆总管结石患者的临床疗效。方法将70例胆囊合并胆总管结石患者作为研究对象,按照手术方案不同分成LCBDE+LC与ERCP/EST+LC两组,统计比较两组手术一般情况、住院情况以及术后并发症,对手术中结石数量、结石最大横径、胆总管内径进行对比,并判定全部患者术后肝功能。结果 LCBDE+LC组患者手术成功率略低于ERCP/EST+LC组,但组间差异无统计学意义(P>0.05);LCBDE+LC组患者出血量、结石残存率、中转开腹率、结石数量、结石最大横径、胆总管内径、总胆红素、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)检测水平、肛门通气时间、住院天数与ERCP/EST+LC组对比,差异无统计学意义(P>0.05);LCBDE+LC组患者手术时长明显短于ERCP/EST+LC组(P<0.05),LCBDE+LC组术后并发症率较低但和ERCP/EST+LC组相比,差异无统计学意义。住院费用低于ERCP/EST+LC组(P<0.05)。结论 LCBDE+LC手术成功率与ERCP/EST+LC成功率较接近,而LCBDE+LC手术可能减少患者并发症,提高患者对手术耐受程度,并且住院耗费相对少,能够帮助患者减轻住院治疗负担,临床实际中应根据患者情况选择首选手术方式,充分发挥微创手术优势。

Objective To compare and evaluate the clinical efficacy of laparoscopic cholecystectomy（ LC）combined with laparoscopic choledocholithotomy（ LCBDE） and endoscopic retrograde cholangiopancreatography and sphincterotomy（ ERCP/EST） in the treatment of cholecystolithiasis and choledocholithiasis. Methods 70 cases of gallbladder and common bile duct stones in patients as the research object,according to the different operation scheme is divided into LCBDE ＋ LC and ERCP/EST ＋ LC two groups,statistics and compared between the two groups in general,hospitalization and postoperative complications were compared to surgery,number of stones stones maximum transverse diameter,the diameter of common bile duct,and all patients with postoperative liver function determination. Results The success rate of operation in LCBDE ＋ LC group was lower than that in ERCP/EST ＋ LC group,but there was no significant difference between groups（ P 〉 0. 05）. LCBDE ＋ LC group patients with bleeding,residual stone rate,transfer to the rate of laparotomy,the number of stones,the largest diameter of stones,common bile duct diameter,total bilirubin,Alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST） levels,anal ventilation time,hospital stay compared with ERCP/EST ＋ LC group,the difference was not statistically significant（ P 〉 0. 05）. The duration of operation in LCBDE ＋ LC group was shorter than that in ERCP/EST ＋ LC group（ P 〈 0. 05）. LCBDE ＋ LC group postoperative complications rate was lower than that of ERCP/EST ＋ LC group,but had no statistical significance. Hospitalization costs were lower than ERCP/EST ＋ LC group（ P 〈 0. 05）. Conclusion LCBDE ＋ LC surgery success rate and success rate of ERCP/EST ＋ LC is close to that of LCBDE ＋ LC,but LCBDE surgery can reduce complications,improve patient tolerance of surgery,and hospitalization cost is relatively small,can help patients to reduce the burden of hospitalization,clinical practice should be chosen according to the preferred mode of operation for the patients,give full play to the advantages of minimally invasive surgery.