ERCP和LCBDE治疗胆总管直径10~15mm的肝外胆道结石疗效比较

Comparison of efficacy of ERCP and LCBDE in the treatment of extrahepatic cholelithiasis with a common bile duct diameter of 10-15 mm

目的分析比较内镜逆行性胰胆管造影(ERCP)胆总管取石+腹腔镜下胆囊切除术(LC)与LC+胆总管切开取石(LCBDE)一期缝合术治疗胆总管直径在10~15 mm之间的肝外胆道结石的效果。方法回顾性分析2015年1月-2019年1月本院收治的127例胆总管直径在10~15 mm之间的肝外胆道结石患者的临床资料,按手术方式的不同分为LC+LCBDE组(35例)和ERCP+LC组(92例)两组。比较两组患者术后并发症及术后恢复情况。结果 LC+LCBDE组手术时间长于ERCP+LC组[(127.37±18.90)min vs.(91.10±11.33)min]、术中出血量多于ERCP+LC组[(21.17±2.86)ml vs.(16.45±2.08)ml],差异均有统计学意义(P<0.05)。LC+LCBDE组与ERCP+LC组比较,在中转开腹率(0.0%vs.2.2%)、术后结石残留率(5.7%vs.7.6%),术后感染(17.1%vs.14.1%)、急性胰腺炎(0.0%vs.5.4%)、出血(0.0%vs.5.4%)、胆漏(5.7%vs.0.0%)、穿孔(0.0%vs.2.2%)等并发症及术后1年结石复发情况发生率(0.0%vs.3.3%)方面,差异无统计学意义(P>0.05);在术后高淀粉酶血症(8.6%vs.25.0%)、术后住院时间[6(6,8)d vs.7(6,8)d]及总住院费用[(1.91±0.16)万元vs.(2.15±0.21)万元]方面,差异有统计学意义(P<0.05)。结论 LC+LCBDE与ERCP+LC两种手术方法均能有效治疗胆总管直径在10~15 mm之间的肝外胆道结石,但视患者的具体情况选择LC+LCBDE术可避免对Oddi括约肌损伤,有助于缩短术后住院时间且手术的经济效益也更为显著。

Objective To analyze and compare the effect of endoscopic retrograde cholangiopancreatography(ERCP) guided choledocholithotomy plus laparoscopic cholecystectomy(LC) and LC plus laparoscopic common bile duct exploration(LCBDE) followed by primary suture in the treatment of extrahepatic cholelithiasis with the diameter between 10 and 15 mm of common bile duct.Methods The clinical data of 127 patients suffering extrahepatic cholelithiasis with diameter of common bile duct between 10 to 15 mm, those admitted to the third affiliated hospital of Zunyi Medical University from January 2015 to January 2019 were analyzed retrospectively. Then, they were divided into LC+LCBDE group(n=35) and ERCP+LC group(n=92) for further comparison on postoperative complications and recovery between the two groups.Results The operation time of LC+LCBDE group was longer than that of ERCP+LC group [(127.37 ±18.90) min vs.(91.10 ±11.33 min)] and the amount of intraoperative blood loss was more than that of ERCP+LC group [(21.17 ±2.86) ml vs.(16.45 ±2.08 ml)], and the differences were statistically significant(P<0.05). Then, the LC+LCBDE group and ERCP+LC group were compared in the following aspects: conversion to laparotomy rate(0.0% vs.2.2%);postoperative stone residual rate(5.7% vs. 7.6%);the complications, such as postoperative infection rate ( 17.1% vs. 14.1%),acute pancreatitis rate( 0.0% vs. 5.4%),bleeding rate( 0.0% vs. 5.4%),bile leakage rate( 5.7% vs.0.0%) and perforation rate( 0.0% vs. 2.2%);stone recurrence rate within 1 year after surgery( 0. 0% vs. 3. 3%),but there were no statistical difference in these aspects. However,there were significant differences in the incidence of postoperative hyperamylasemia( 8.6% vs. 25.0%),postoperative hospital stay [6( 6,8) d vs. 7( 6,8) d]and total hospitalization cost [( 1.91 ±0.16) ten thousand yuan vs.( 2.15 ±0.21) ten thousand yuan]( P<0.05).Conclusions Both operation methods of LC+LCBDE and ERCP+LC could effectively treat extrahepatic cholelithiasis with common bile duct diameter between 10 to15 mm. However,it could observably avoid the injury of Oddi sphincter,help to shorten the postoperative hospital stay and save the cost of operation to select LC+LCBDE under some specific conditions of patients.