ERCP+LC与LCBDE+LC治疗胆总管结石合并急性胆管炎的临床分析

Clinical analysis of ERCP+LC and LCBDE+LC in treatment of choledocholithiasis complicated with acute cholangitis

目的探究腹腔镜胆总管探查取石术(LCBDE)与内镜下逆行胆胰管造影胆总管取石术(ERCP)联合胆囊切除术(LC)治疗胆总管结石合并急性胆管炎的疗效。方法选择298例胆总管结石合并急性胆管炎患者,按照手术方式不同将患者分为LCBDE组与ERCP组,比较两组术中出血量、手术时间、中转开腹率、取石率、术后恢复及术后并发症发生情况。结果 ERCP组手术时间、出血量、术后排气时间、活动恢复时间、住院时间及住院费用均低于LCBDE组(P <0.05),但术后急性胰腺炎、消化道出血等并发症发生率显著高于LCBDE组(P <0.05)。结论 ERCP+LC治疗胆总管结石合并急性胆管炎的术后恢复较快,而LCBDE+LC并发症较少,临床应根据患者病情及适应证选择合适术式。

Objective To explore the efficacy of laparoscopic choledocholithotomy(LCBDE)and endoscopic retrograde cholangiopancreatography(ERCP)combined with laparoscopic cholecystectomy(LC)in the treatment of choledocholithiasis with acute cholangitis.MeAods A total of 298 patients of choledocholithiasis complicated with acute cholangitis were selected and divided into LCBDE group and ERCP group according to different operational methods.The amount of bleeding during operation,operation time,conversion rate,stone removal rate,postoperative recovery and complications were compared between the two groups.Results The operation time,bleeding volume,exhausting time,activity recovery time,hospitalization time and hospitalization expenses of the ERCP group were lower than those of the LCBDE group(P<0.05),but the incidences of complications such as acute pancreatitis and gastrointestinal bleeding after operation were significantly higher than those of LCBDE group(i5<0.05).Conclusion ERCP+LC can ensure quicker recovery in the treatment of choledocholithiasis complicated with acute cholangitis,while LCBDE+LC has fewer complications.The appropriate operational method should be selected according to the patient's condition and indications.