腹腔镜胆囊切除术+LCBDE胆管一期缝合术与ERCP+腹腔镜胆囊切除术两种手术方式的疗效和安全性对比

Efficacy and safety:laparoscopic cholecystectomy+LCBDE vs.ERCP+laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查术(LCBDE)胆管一期缝合术与ERCP+LC两种手术方式的疗效和安全性。方法选取2018年9月至2020年9月本院接诊的275例胆囊结石合并胆总管结石患者,采用自愿入组方式将患者分为分为两组。对照组行LC+ERCP,观察组行LC+LCBDE胆管一期缝合手术,比较两组患者临床疗效和安全性。结果对照组术中出血量低于观察组出血量(P<0.001);对照组患者住院时间、住院费用、结石残留及肝功能异常率高于观察组(P<0.05);Logistic回归分析结果显示,对患者预后产生影响的因素为术后出血量、住院时间、费用及肝功能指标异常(P<0.05);观察组取石率高于对照组(P<0.05);两组并发症发生差异无统计学意义(P>0.05)。结论LC+LCBDE胆管一期缝术疗效和安全性更高,利于改善患者的临床肝功能指标,减少患者住院时间和费用,临床价值较高,值得推广应用。

Objective To compare the efficacy and safety of two approaches:laparoscopic cholecystectomy(LC)+laparoscopiccommon bile duct exploration(LCBDE)single⁃stage bile duct suture andendoscopic retrograde cholangiopancreatography(ERCP)+LC.Methods A total of 275 patients with cholecystolithiasis complicated with choledocholithiasis admitted to our hospital from September 2018 to September 2020 were selected and divided into control and observation groups in the study.LC+ERCP was performed in the control group,and LC+LCBDE was performed in the observation group.The clinical efficacy and safety of the two groups were compared.Results The amount of intraoperative bleeding in the control group was lower than that in the observation group(P<0.001).As compared with the observation group,the hospitalization time was significantly longer,the hospitalization cost significantly larger and the rates of stone residue and abnormality of liver function were significantly higherin the control group(P<0.05).Logistic regression analysis showed that the factors affecting the prognosis were postopera⁃tive blood loss,length of stay,cost and abnormal liver function indexes(P<0.05).The lithotomy rate of the observa⁃tion group was significantly higher than that of the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion LC+LCBDE primary bile duct suture has higher efficacy and safety,which is beneficial for the improvement of clinical liver function indexes,reduction of hospital stay and lowering of cost.It is of high value clinically,worthy of promotion and application.