经皮经肝十二指肠乳头肌球囊扩张联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石

Concurrent percutaneous transhepatic papillary balloon dilatation combined with laparoscopic cholecystectomy for gallstones and common bile duct stones

目的探讨经皮经肝十二指肠乳头肌球囊扩张术（percutaneous transhepatic papillary balloon dilatation，PTBD）联合腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）治疗胆总管结石合并胆囊结石的临床疗效和价值。方法回顾性分析自2010年9月至2016年12月23例采用PTBD＋LC与34例采用腹腔镜胆总管探查取石术（1aparascopic common bile duct exploration，LCBDE）＋LC治疗胆总管结石合并胆囊结石患者的临床资料，对比两种术式的疗效。结果PTBD＋LC组（23例）：手术成功率91．3％，术后并发症（胰腺炎2例、肺部感染3例、切口感染1例），术后残石率4．3％。LCBDE＋LC组（34例）：手术成功率88．2％，术后并发症（胆漏2例、肺部感染2例、切口感染1例）术后残石率2．9％；两组患者的手术成功率、术后并发症及术后残石率比较，差异均无统计学意义（均P〉0．05）。两组患者的手术时间，术后肛门排气时间，住院费用比较，差异均无统计学意义（均P〉0．05）。PTBD＋LC组术后住院时间较LCBDE＋LC组短，差异有统计学意义（P〈0．05）。结论PTBD＋LC为不适合内镜治疗的胆总管结石合并胆囊结石患者提供了一种新的治疗途径，是一种安全有效的治疗方法。

Objective To evaluate the clinical effectiveness and safety of percutaneous transhepatic papillary balloon dilatation （PTBD） combined with laparoscopic cholecystectomy （LC） for concurrent gallstones and common bile duct stones. Methods From Sep 2010 to Dec 2016, 23 patients undergoing PTBD ＋ LC were retrospectively compared with 34 cases recieving laparascopic common bile duct exploration （LCBDE） ＋ LC. Parameters included surgical success rate, postoperative complications, residual stone rate, operation time, postoperative anal exhaust time, postoperative hospital stay, and hospitalization expenses. Results In this study 23 patients received PTBD ＋ LC, 34 patients received LCBDE ＋ LC. In PTBD ＋ LC group： the operation success rate was 91.3%, postoperative complications （2 cases of pancreatitis, 3 cases of pulmonary infection, 1 case of ineisional infection） , and the postoperative residual stone rate was 4. 3%. In LCBDE ＋ LC group： surgery success rate was 88.2% , postoperative complications （bile leakage 2 cases, lung infection 2 cases, incisional infection 1 case ） , postoperative residual stone found in 2. 9% ; The success rate, postoperative complications and postoperative residual stone rate between the two groups were not statistically different （ P 〉 0. 05 ）, nor in operation time, postoperative anal exhaust time, and hospitalization cost （ P 〉 0. 05 ）. PTBD ＋ LC group had shorter hospital stay （ P 〈 O. 05 ）. Conclusions PTBD combined with LC is effective and safe procedure for the treatment of gallstones and bile duct stones.