2种方法治疗急性胆囊结石合并胆总管结石的比较

Comparison of Two Treatments in Treating Acute Cholecystolithiasis and Choledocholithiasis

目的比较腹腔镜胆囊切除术(LC)+术中内镜逆行胰胆管造影(ERCP)和LC+腹腔镜胆道探查术(LCBDE)在治疗急性胆囊结石合并胆总管结石中的疗效。方法选择201401-201605月在我院进行LC的104例胆总管结石患者作为研究对象。根据治疗方式分为LC+ERCP组(n=52)和LC+LCBDE组(n=52)。比较2组患者结石清除率、结石残留率、术后并发症、病死率、术后住院天数、开腹手术率和手术时间等。结论LC+ERCP组结石清除率为87%,LC+LBDE组为69%(P=0.057)。LC+ERCP组结石残留率低于LC+LBDE组,分别为15%和42%(P=0.004)。LC+LBDE组患者术后平均住院时间短于LC+ERCP组(2d vs.3d,P=0.015)。结论与LC+LBDE相比,术中LC+ERCP在治疗胆囊结石合并胆总管结石中能最大限度地降低胆总管结石患者的结石残留率。

Objective To compare laparoscopic cholecystectomyintraoperative(LC)+ intraoperative endoscopic retrograde cholangiopancreatography (ERCP) with LC+ laparoscopic bile duct exploration (LCBDE) in cholecystolithiasis and choledocholithiasis. Methods 104 patients with choledocholithiasis who underwent laparoscopic cholecystectomy in our hospital from January 2014 to May 2016 were selected. The subjects were randomly divided into LC+ERCP group (n=52) and LC+LCBDE group (n=52). The primary outcomes were rates of bile duct clearance and retained stones. Secondary outcomes were postprocedure complication rate, mortality rate, postoperative length of hospital stay, conversion to open surgery rate, procedural time and total duration of surgery. Results Duct clearance rates were 87 percent for patients who had LC+ ERCP and 69 percent for those in the LC+ LCBDE group (P =0.057). The rate of retained stones was lower in the LC+ERCP group than in the LC+LCBDE group: 15 versus 42 percent respectively (P =0.004). Median postoperative length of stay was shorter with LC+ERCP (2 days versus 3 days for LCBDE, P =0.015). Conclusion LC+ ERCP is more effective than LC+ LCBDE in terms of minimizing the rate of retained stones in patients with cholecystolithiasis and choledocholithiasis undergoing emergency laparoscopic cholecystectomy.