腹腔镜下不同手术方式治疗胆囊结石及胆总管结石的临床效果比较

Comparison of efficacy and safety of laparoscopic surgery for gallstones and common bile duct stones

目的探讨腹腔镜两种手术方式治疗胆囊结石及胆总管结石的疗效及安全性。方法选取2015年12月至2017年12月舟山医院收治并行腹腔镜下手术的胆囊结石合并胆总管结石患者87例为研究对象,采用随机数字表法将患者分成A组(38例)与B组(49例)。A组采取腹腔镜胆囊切除术(LC)联合腹腔镜胆总管探查术(LCBDE),B组则采取内镜下逆行胰胆管造影(ERCP)及乳头括约肌切开取石术(EST)联合腹腔镜胆囊切除术(LC)。观察两组手术治疗疗效,对两组患者行不同手术方式的手术时间、手术成功率以及开腹中转率进行记录,同时对比分析两组患者相应住院时间及所花费费用情况。并在术后对两种不同手术的安全性进行比较,记录两组患者的并发症情况。结果A组患者中胆总管结石直径为(1.02±0.25)cm,胆总管直径为(1.15±0.25)cm,结石数目(单发/多发)13/25枚;B组患者中胆总管结石直径为(0.99±0.26)cm,胆总管直径为(1.13±0.26)cm,结石数目(单发/多发)18/31枚;两组差异均无统计学意义(t=0.513、0.437、0.367,P=2.083、1.533、1.095);A组手术成功率为92.11%(35/38),B组患者手术成功率为91.84%(45/49),两组差异无统计学意义(χ^2=0.006,P=0.974);B组并发症发生率为20.41%,显著高于A组(χ^2=3.654,P=0.019);A组住院时间、住院费用分别为(10.6±2.6)d、(26 649.8±3 478.6)元,均显著优于B组(t=21.971、17.168,均P<0.05)。结论对于胆囊结石合并胆总管结石患者采用LC联合LCBDE的治疗效果及住院时间、住院费用等均优于ERCP/EST联合LC手术治疗方式,且前者安全性较后者更高。

Objective To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.Methods Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases)underwent laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE),and B group(49 cases)underwent endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic sphincterotomy(EST)combined with laparoscopic cholecystectomy(LC).The curative effect of the two groups was observed.The operation time,the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery,and the complications of the two groups were recorded.Results In A group,the average diameter of common bile duct stones was(1.02±0.25)cm,the average diameter of common bile duct diameter was(1.15±0.25)cm.In B group,the mean diameter of common bile duct stones was(0.99±0.26)cm,and the average diameter of common bile duct was(1.13±0.26)cm.The differences between the two groups were not statistically significant(t=0.513,0.437,0.367,P=2.083,1.533,1.095).The successful operation rate of A group was 92.11%(35/38),which in B group was 91.84%(45/49),the difference was not statistically significant between the two groups(χ^2=0.006,P=0.974).The incidence rate of complications in B group was 20.41%,which was significantly higher than that in A group,the difference was statistically significant(χ^2=3.654,P=0.019).The hospitalization time,hospitalization expenses in A group were(10.6±2.6)d,(26 649.8±3 478.6)CNY,respectively,which were significantly better than those in B group(t=21.971,17.168,all P<0.05).Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery,and the safety of the former is higher than the latter.