内镜保胆取息肉术与腹腔镜胆囊切除术治疗胆固醇性息肉的临床对比

Clinical comparison of endoscopic minimally invasive polypectomy with gallbladder preservation and laparoscopic cholecystectomy for cholesterol polyps

目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围术期指标、并发症发生率,观察两组远期疗效。结果两组术前资料具有可比性(P>0.05)。内镜取息肉术组手术时间[M(P25,P75),58(52,67)min vs 59(56,70)min]、术中出血量[(12.9±5.2)m L vs(16.6±4.7)m L]、术后排气时间[(17.3±5.3)h vs(21.0±3.8)h]、下床活动时间[M(P25,P75),8(6,15)h vs 12(8,19)h]、住院时间[(6.9±1.5)d vs(7.3±1.3)d]、腹痛和腹泻发生率(1.39%vs 6.15%)、总并发症发生率(3.24%vs 12.85%),均明显低于LC组(Z/χ2:-2.195,7.262,7.953,-6.410,2.330,4.749,10.988;均P<0.05)。随访截至2018年1月,随访时间12~72个月,中位随访41个月,失访率:内镜取息肉术组9.26%(20/216),LC组8.94%(16/179)。随访6年内,内镜取息肉术组复发率6.63%(13/196),LC组肝内外胆管结石发生率1.23%(2/163)。结论对于PLG可能为胆固醇性且有手术指征或处于指征边缘的患者,若无法坚持定期复查,内镜取息肉术不失为手术治疗方法中的优选。

Objective To investigate the efficacy of endoscopic minimally invasive polypectomy with gallbladder preservation for cholesterol polypoid lesion of gallbladder（PLG）. Methods The clinical data of 395 pathologically diagnosed cholesterol PLG patients in Xinjiang Military District Hospital from Jan. 2012 to Jan. 2017 was retrospectively analyzed. Among them, 216 cases underwent endoscopic minimally invasive polypectomy with gallbladder preservation, and 179 cases underwent laparoscopic cholecystectomy（LC）. The perioperative indexes, postoperative complication incidence, and the long-term efficacy were compared between the two groups. Results The general data before operation was comparable between two groups（P〉0.05）. The operation duration [58（52, 67）min vs 59（56, 70） min], bleeding volume [（12.9±5.2） mL vs（16.6±4.7） mL], postoperative venting time [（17.3±5.3） h vs（21.0±3.8） h], ambulation time [8（6, 15） h vs 12（8, 19） h], hospitalization duration [（6.9±1.5） d vs（7.3±1.3） d], abdominal pain and diarrhea incidence（1.39% vs 6.15%） and total complication incidence（3.24% vs 12.85%） in the endoscopic minimally invasive polypectomy with gallbladder preservation group were all less than those in the LC group（Z/χ2：-2.195, 7.262, 7.953,-6.410, 2.330, 4.749, 10.988; all P〈0.05）. Follow-up ended in Jan. 2018, the follow-up time was 12 to 72 months, and the median follow-up time was 41 months. The rate of follow-up loss was 9.26%（20/216） in the endoscopic minimally invasive polypectomy with gallbladder preservation group and 8.94%（16/179） in the LC group. The recurrence rate was 6.63%（13/196） in the endoscopic minimally invasive polypectomy with gallbladder preservation. The incidence of intrahepatic and exprahepatic bile duct stones in the LC group was 1.23%（2/163）. Conclusion For patients whose PLG may be cholesterol and have surgical indications or at the edge of indications, endoscopic minimally invasive polypectomy with gallbladder preservation is preferred.