LC/CBDE与ERCP/EST+LC治疗胆总管结石的手术效果与经济性对比

Surgical Effect and Economic Comparison of Primary LC/CBDE and Staging ERCP/EST+LC in the Treatment of Common Bile Duct Stones

目的对比一期腹腔镜胆囊切除术/胆总管探查术(LC/CBDE)与分期逆行性胰胆管造影术(ERCP)/内镜下十二指肠乳头括约肌切开术(EST)+腹腔镜胆囊切除术(LC)治疗胆总管结石的手术效果与经济性。方法回顾性分析2017年3月~2018年1月我院收治的60例胆总管结石患者资料,按照手术方式将所有患者分为LC/CBDE组(n=30)及ERCP/EST组(n=30)。其中LC/CBDE组采用LC/CBDE治疗,而ERCP/EST组采用ERCP/EST后非同日LC进行治疗。分别比较两组患者手术情况及经济性,取石次数及转开腹手术率,术前及术后3 d内实验室检查指标,并发症发生率之间的差异。结果 LC/CBDE组患者住院天数、手术费用及住院费用显著低于ERCP/EST组(P<0.05)。LC/CBDE组患者多发结石及结石最大直径≥1cm的取石次数显著低于ERCP/EST组(P<0.05)。LC/CBDE组患者术后1d时WBC及GGT显著低于ERCP/EST组(P<0.05)。LC/CBDE组患者术后并发症发生率显著低于ERCP/EST组(P<0.05)。结论 LC/CBDE术较ERCP/EST+非同日LC术具有更好的经济性,能有效节省患者费用,同时能减少取石次数,且安全性较高,但是在临床术式选择上仍需要全面考虑患者情况。

Objective To compare the clinical effect and economy of one-stage LC/CBDE with sequential ERCP/EST+LC in the treatment of common bile duct stones.Methods A retrospective analysis of 60 patients with choledocholithiasis admitted to our hospital from March to February 2018 was performed.All patients were divided into LC/CBDE group (n=30) and ERCP/EST group(n=30) according to surgical methods.The LC/CBDE group was treated with primary LC/CBDE,while the ERCP/EST group was treated with ERCP/EST and sequential LC.It was compared between the two groups of the surgical condition and economy,the number of stones and the rate of conversion to laparotomy,the difference between the laboratory test indicators and the incidence of complications within 3 days before and after surgery.Results The hospital stay,operation time was shorter and the hospitalization costs were significantly lower in LC/CBDE group than in ERCP/EST group (P<0.05).The procedure times of lithotomy of multiple stones,and ≥1 cm stones in the LC/CBDE group was significantly lower than that in ERCP/EST group (P<0.05).WBC and GGT were significantly lower in LC/CBDE group than in ERCP/EST group 1 day after surgery(P<0.05).The incidence of postoperative complications was significantly lower in LC/CBDE group than in ERCP/EST group (P<0.05).Conclusion One-stage LC/CBDE is more economical than ERCP/EST+sequential LC,and it can reduce the procedure times of lithotomy safely.However,it is necessary to fully consider the patient's condition in clinical surgical selection.