ERCP联合LC与LC联合LCBDE治疗胆囊结石合并胆管结石的远期疗效比较

The comparison of long-term effection on ERCP+LC and LC+LCBDE for the treatment of gallbladder stones combined with bile duct stones

目的比较内窥镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)(ERCP+LC)与LC联合腹腔镜下胆总管切开取石术(laparoscopic common bile duct exploration,LCBDE)(LC+LCBDE)对胆囊结石合并胆总管结石的远期治疗效果。方法回顾性分析ERCP+LC或LC+LCBDE治疗114例胆囊结石合并胆总管结石的患者,采用单因素及多因素分析的方法进行危险因素分析。结果ERCP+LC组患者中位随访时间24(范围:8~49)个月,中位无结石生存时间25个月,1、2、3年复发比例分别为13%、41%、47%。LC+LCBDE组患者中位随访时间为23.5(4~52)个月,中位无结石生存时间为24(17~48)个月,1、2、3年复发率分别为3%、27%、32%。多因素分析发现,胆总管直径≥1.2cm(P=0.011)、初始治疗方案(ERCP+LC/LC+LCBDE,P=0.013)是结石复发的主要危险因素。结论内窥镜取石过程中行胆管下段括约肌切开可能增加结石远期复发。在胆管扩张的情况下,腹腔镜下胆总管切开取石可能是更好的选择。

Objective To compare the long-term effect of endoscopic retrograde cholangiopancreatography(ERCP)combined laparoscopic cholecystectomy(LC)(ERCP+LC)and LC combined laparoscopic common bile duct exploration(LCBDE)(LC+LCBDE)on the treatment of bile duct stones combined with gallbladder stone.Methods Clinical and recurrence-free survival data of114 patients with concomitant gallbladder and common bile duct(CBD)stones who received LC+LCBDE/ERCP+LC as initial treatment were retrospectively reviewed and prognostic risk factors were analyzed by univariate and multivariate analysis.Results In ERCP+LC group,median follow-up period was 24(range 8~49)months,disease-free survival time was 25 months,and recurrence rates at 1,2,and 3 years were 13%,41%,and 47%respectively.In LC+LCBDE group,median follow-up period was 23.5(4~52)months,disease-free survival time was 24(17~48)months,and recurrence rates at 1,2,and 3 years were 3%,27%,and 32%respectively.Multivariate analysis identified the diameters of CBD≥1.2 cm(P=0.011),initial treatment(ERCP+LC/LC+LCBDE)(P=0.013)were independent risk factors for long-term recurrence of CBD stones.Conclusion Sphincterotomy of the lower bile duct during endoscopic stone removal may increase the long-term recurrence of stones.LC+LCBDE may be the more suitable option to avoid long-term recurrence of CBD stones.