一步法腹腔镜与分步法内镜加腹腔镜治疗胆囊结石合并胆总管结石

One-stage laparoscopic versus two-stage endoscopic followed by laparoscopic treatment for cholecystolithiasis complicated with choledocholithiasis

目的比较一步法腹腔镜胆囊切除(LC)并胆总管探查取石(LCBDE)及一期缝合术(PS),与分步法内镜逆行胰胆管造影(ERCP)/乳头括约肌切开术(EST)联合LC治疗胆囊结石合并胆总管结石的临床疗效。方法回顾性分析2016年1月至2017年12月行微创治疗的171例胆囊结石合并胆总管结石患者资料,其中90例采用一步法术式,81例采用分步法术式,对比两组相关指标的差异。结果一步法组与分步法组患者手术成功率(94.4%比95.1%)、残余结石率(3.3%比4.9%)及术后并发症发生率(6.7%比8.6%)等差异均无统计学意义(均P>0.05);与分步法组相比,一步法组手术时间缩短(110.4比135.7 min)、术后住院时间更短(4.5比7.1 d)、住院费用更低(22756.2比31429.3元),且远期并发症发生率低(2.2%比9.9%),差异均具有统计学意义(均P<0.05)。结论一步法及分步法均为安全、有效术式。一步法在患者住院时间、住院费用方面具有明显优势,且保护了Oddi括约肌,应作为多数情况下的首选术式。

Objective To compare the clinical efficacy of one-stage laparoscopic cholecystectomy(LC)plus laparoscopic common bile duct exploration(LCBDE)with primary suture(PS)versus two-stage endoscopic retrograde cholangiopancreatography(ERC P)/endoscopic sphincterotomy(EST)followed by LC in treatment of cholecystolithiasis complicated with choledocholithiasis.M ethods The clinical data of 171 patients with cholecystolithiasis complicated with choledocholithiasis,who underwent minimally invasive surgical treatment from January 2016 to December 2017,were retrospectively analyzed.Of these patients,90 underwent one-stage LC+LCBDE+PS(the one-stage group),and 81 underwent two-stage ERCP/EST followed by LC(the two-stage group).The main clinical variables between the two groups of patients were compared.Results The surgical success rates(94.4% vs.95.1%),residual stone rates(3.3% vs.4.9%)and incidences of postoperative complications(6.1% vs.8.6%)showed no significant difference(all P>0.05)between the one-stage and two-stage groups.Compared with the two-stage group,the operative time was shorter(110.4 vs.135.7 min),the length of postoperative hospital stay was shorter(3.3 vs.7.1 d)and the total hospitalization cost was reduced(22756.2 vs.31429.3 yuan)in the one-stage group.The incidence of long-term complications(2.2% vs.9.9%)in the one-stage group was also lower than that in the two-stage group(both P<0.05).Conclusions Both one-stage LC+LCBDE+PS and two-stage ERCP/EST+LC are safe and effective in the treatment of cholecystolithiasis complicated with choledocholithiasis.One-stage LC+LCBDE+PS shows obvious advantages in hospitalization stay,hospitalization cost and in the preservation of function of the Oddi sphincter,and therefore should be the first choice in most cases.