同一术者ERCP+LC与LECBD+LC治疗胆囊结石合并胆总管结石的对比分析

Comparative analysis on ERCP+LC versus LECBD+LC for cholecystolithiasis combined with choledocholithiasis by the same operator

目的比较同一术者操作的内镜下逆行性胆胰管造影+腹腔镜胆囊切除术(ERCP+LC)和腹腔镜胆总管探查+腹腔镜胆囊切除术(LECBD+LC)两种微创手术治疗胆囊结石合并胆总管结石的临床疗效。方法收集2017年1月至2018年7月期间香港大学深圳医院肝胆胰外科收治的胆囊结石合并胆总管结石病例102例,患者接受同一术者操作的ERCP+LC(n=65)或LECBD+LC(n=37),对两组手术中转率、胆总管结石清除率、手术时间、手术出血量、术后并发症发生率、住院时间等临床数据进行统计比较。结果ERCP+LC组在手术时间[(129.88±47.91)min vs(183.54±74.75)min,P<0.05]、住院时间[(7.15±3.14)d vs(10.68±5.00)d,P<0.05]方面优于LECBD+LC组;在手术中转率、胆总管结石清除率、手术出血量、手术并发症发生率方面,两组无统计学差异(P>0.05)。结论ERCP+LC和LECBD+LC均是治疗胆总管结石合并胆囊结石的有效方法,应该根据患者的具体情况进行选择,术者同时熟练掌握两种方法才可能使患者获益。

Objective To compare the therapeutic effects of endoscopic retrograde cholangiopancretography+laparoscopic cholecystectomy(ERCP+LC)versus laparoscopic exploration of common bile duct+laparoscopic cholecystectomy(LECBD+LC)in treatment of cholecystolithiasis combined with choledocholithiasis operated by the same surgeon.Methods The clinical data of 102 patients with cholecystolithiasis combined with choledocholithiasis who treated in The University of Hong Kong-Shenzhen Hospital from Jan.2017 to Jul.2018 were retrospectively analyzed.All the operations were performed by the same surgeon,65 cases were treated by ERCP+LC and 37 cases were treated by LECBD+LC.The clinical data such as conversion rate,choledocholithiasis clearance rate,total operation time,operation blood loss,postoperative complication rate and hospitalization time were compared between the two groups.Results No death occurred in either group.Compared with those in LECBD+LC group,the total operation time[(129.88±47.91)min vs(183.54±74.75)min,P<0.05]and hospitalization time[(7.15±3.14)d vs(10.68±5.0)d,P<0.05]were shorter in ERCP+LC group.There were no significant differences between the two groups in conversion rate,choledocholithiasis clearance rate,intraoperative blood loss,or postoperative complication rate(P>0.05).Conclusion ERCP+LC and LECBD+LC are both effective methods for treatment of choledocholithiasis combined with cholecystolithiasis,which should be selected according to the specific conditions of the patient.Only proficient in both methods may benefit the patient.