LCBDE+LC+胆管一期缝合与ERCP/EST+LC在治疗胆囊结石合并胆总管结石的比较

Comparison of clinical effect of LCBDE + LC + primary closure and ERCP/EST + LC in the treatment of cholecystolithiasis with choledocholithiasis

目的比较腹腔镜胆总管探查取石(LCBDE)+腹腔镜胆囊切除(LC)+胆管一期缝合与内镜逆行胰胆管造影/内镜下十二指肠乳头括约肌切开取石(ERCP/EST)+LC治疗胆囊结石合并胆总管结石的临床疗效。方法回顾性分析我院2015年1月-2020年1月治疗的118例胆囊结石合并胆总管结石患者的临床资料,其中LCBDE+LC+胆管一期缝合组(LCBDE组)82例,ERCP/EST+LC组(ERCP/EST组)36例。对比两组在手术时间、中转开腹率、住院费用、术后住院时间、术后并发症发生率及结石清除率等指标上的差异。结果两组患者在年龄、性别、胆总管结石数、白细胞计数、中转开腹率及结石清除率等指标上的差异无统计学意义(P>0.05);LCBDE组胆总管直径大于ERCP/EST组[(10.82±2.30)cm vs(9.30±2.42)cm],差异具有统计学意义(P<0.05);LCBDE组手术时间长于ERCP/EST组[134.66±17.93)min vs(111.31±10.77)min],差异具有统计学意义(P<0.05);LCBDE组在术后住院时间[(5.38±1.19)d vs(12.31±2.68)d]、住院费用[(29888.71±3785.5)元vs(50071.31±9322.25)元]、术后并发症发生率[4.88%(4/82) vs 19.44%(7/36)]指标上均低于ERCP/EST组,差异具有统计学意义(P<0.05)。结论LCBDE+LC+胆管一期缝合与ERCP/EST+LC两种手术均是治疗胆囊结石合并胆总管结石有效且安全的方式,但与ERCP/EST+LC相比,采用LCBDE+LC+胆管一期缝合除手术时间略长外,可明显缩短患者的术后住院时间,降低住院费用,减少术后并发症的发生率,该术式既能保存Oddi括约肌的功能,又能避免T管引流带来的不便,在合适的适应症下可作为首选术式。

Objective To compare the clinical efficacy of laparoscopic choledocholithotomy(LCBDE) combined with laparoscopic cholecystectomy(LC) combined with primary closure and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy(ERCP/EST) combined with LC in the treatment of cholecystolithiasis with choledocholithiasis. Methods Clinical data of 118 patients with cholecystolithiasis complicated with choledocholithiasis treated in The First People’s Hospital of Jiujiang from January 2015 to January 2020 were retrospectively analyzed, of which 82 were in LCBDE + LC + primary closure group(LCBDE group) and 36 were in ERCP/EST + LC group(ERCP/EST group).The two groups were compared in terms of operation time, rate of transfer to laparotomy, hospitalization cost, postoperative hospital stay, incidence of postoperative complications and disposable stone clearance rate. Results There was no statistically significant difference between the two groups in terms of age,gender, number of common bile duct stones, white blood cell count, rate of transfer to laparotomy and disposable stone clearance rate.(P>0.05).The diameter of common bile duct in the LCBDE group was larger than that in the ERCP/EST group [(10.82±2.30)cm vs(9.30±2.42) cm], and the difference was statistically significant(P<0.05).The operation time of LCBDE group was longer than that of ERCP/EST group [134.66±17.93) min vs(111.31±10.77) min], and the difference was statistically significant(P<0.05).In terms of postoperative hospital stay [(5.38±1.19) d vs(12.31±2.68) d], hospitalization cost [(29888.71±3785.5) yuan vs(50071.31±9322.25) yuan] and incidence of postoperative complications [4.88%(4/82) vs 19.44%(7/36)], the difference was statistically significant(P <0.05). Conclusion LCBDE + LC + primary closure and ERCP/EST + LC are both effective and safe ways to treat cholecystolithiasis with choledocholithiasis, but compared with ERCP/EST + LC, adopting LCBDE + LC + primary closure in addition to a slightly longer surgical time, can obviously shorten the patient’s postoperative hospital stay, reduce hospitalization cost, reduce the incidence of postoperative complications, the operation can not only save Oddi sphincter function, and can avoid the T tube drainage inconvenience. It can be used as the first choice under appropriate indications.