腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石两种术式的临床对照研究

Clinical Control Study of Laparoscopic Combined with Choledochoscopy in the Treatment of Gallbladder Stones Combined with Common Bile Duct Stones

目的:探讨腹腔镜胆囊切除(LC)联合经胆囊管取石术(LTSE)与腹腔镜胆囊切除联合胆总管切开取石术(LCH)两种术式治疗胆囊结石合并胆总管结石的临床效果。方法:前瞻性收集2010年1月-2016年6月于本院治疗的胆囊结石合并胆管结石的患者,将符合入组条件的患者按照手术方式的不同分为LC+LTSE组和LC+LCH组。术后随访3~12个月,收集并整理术前、术中及术后临床资料,进行统计学分析。结果:LC+LTSE组手术时间、术后住院时间及住院费用均显著优于LCH组,差异均有统计学意义(P<0.05)。两组结石清除率比较,差异无统计学意义(P>0.05)。LC+LTSE组胆漏发生率显著低于LCH组,差异有统计学意义(P<0.05);而两组的急性胰腺炎、腹腔感染发生率比较,差异均无统计学意义(P>0.05)。LC+LTSE组胆管狭窄发生率明显低于LC+LCH组,差异有统计学意义(P<0.05),而两组结石复发率比较,差异无统计学意义(P>0.05)。结论:LC+LTSE是腹腔镜下治疗胆囊结石合并胆总管结石首选手术方式,对无法经胆囊管胆道镜探查者可考虑LC+LCH方案。

Objective：To investigate the clinical effects of laparoscopic cholecystectomy（LC） combined with transcystic stone extraction（LTSE） and LC combined with laparoscopic choledocholithotomy（LCH） in the treatment of gallbladder stones combined with common bile duct stones.Method：We prospectively collected patients with cholecystolithiasis and cholelithiasis treated in our hospital from January 2010 to June 2016,patients eligible for inclusion were divided into LC＋LTSE group and LC＋LCH group according to different surgical methods,they were followed up for 3-12 months post operation.The clinical data of preoperative,intraoperative and postoperative were collected and analyzed statistically.Result：The operation time,postoperative hospital stay and hospitalization cost in LC＋LTSE group were significantly better than those in LCH group,the differences were statistically significant（P〈0.05）.Comparison of calculi clearance rates between the two groups showed no significant difference（P〉0.05）.The rate of biliary leakage in LC＋LTSE group was significantly lower than that in LCH group,the difference was statistically significant（P〈0.05）.However,there were no statistically significant differences in the incidence of acute pancreatitis and abdominal infection between the two groups（P〉0.05）.The incidence rate of bile duct stricture in the LC＋LTSE group was significantly lower than that in the LC＋LCH group,the difference was statistically significant（P〈0.05）,while the recurrence rate of stones in the two groups was not statistically significant（P〉0.05）.Conclusion：LC＋LTSE is the preferred surgical method for the treatment of gallbladder stones combined with choledocholithiasis under laparoscopy,the LC＋LCH scheme can be considered for those who cannot pass through the gallbladder tube and choledochoscope.