胆囊合并胆总管结石的内镜与腹腔镜治疗的临床对比

Clinical comparison of laparoscopic common bile duct stone removal and endoscopic stone removal

目的对比研究胆囊合并胆总管结石在腹腔镜下一期行胆囊切除并胆总管切开取石(LCBDE+LC)与内镜ERCP/EST取石后行腹腔镜胆囊切除术(ERCP/EST+LC)的临床效果。方法选取胆总管结石患者60例,根据治疗方案不同分为腹腔镜组(n=30)、内镜组(n=30)。腹腔镜组给予腹腔镜胆囊切除加胆总管切开取石治疗,内镜组给予内镜下括约肌切开取石治疗后住院期间行腹腔镜胆囊切除术。比较两组手术情况、术后恢复情况、结石残留率及并发症发生情况,并随访1年,统计对比两组结石复发率。结果腹腔镜组手术总费用较少,但术中失血量较内镜组多(t_(1)=6.133,P_(1)<0.001;t_(2)=6.189,P_(2)<0.001),手术用时、住院时间较内镜组短,但无明显差异(t_(1)=1.189,P_(1)=0.221;t_(2)=3.604,P_(2)=0.326);腹腔镜组结石残留率6.67%(2/30)较内镜组13.33%(4/30)低,但无明显差异(χ^(2)=4.320,P=0.061);腹腔镜组并发症发生率20%(6/30)较内镜组16.67%(5/30)高,但无明显差异(χ^(2)=0.647,P=0.421);随访1年,腹腔镜组结石复发率10.00%(3/30)较内镜组3.33%(1/30)高,但无明显差异(χ^(2)=2.588,P=0.108)。结论内镜取石后序惯行腹腔镜胆囊切除术与腹腔镜胆囊切除+胆总管切开取石术两种治疗方案对治疗胆囊合并胆总管结石均是安全、确切有效的。LCBDE+LC方案费用较少,手术后结石残留率稍低,但术中失血量较多,术后出现胆漏、胆管狭窄、结石复发等并发症较高;而ERCP/EST+LC治疗方案费用较高,但术后并发症及结石复发率低,且适用范围广。

Objective To compare the clinical effects of laparoscopic common bile duct stone removal and endoscopic stone removal.Methods 60 patients with common bile duct stones in our hospital were enrolled.The treatment options were divided into laparoscopic group(30 cases)and endoscopy group(30 cases).The laparoscopic choledocholithiasis was performed in the laparoscopic group and endoscopic sphincterotomy was performed in the endoscopy group.The operation status,postoperative recovery,residual rate of stones and complications were compared between the two groups.The follow-up period was 1 year.The recurrence rate of stones was compared statistically.Results The total cost of surgery in the laparoscopic group is less,but the blood loss during the operation is greater than that in the endoscopic group(t_(1)=6.133,P_(1)<0.001;t_(2)=6.189,P_(2)<0.001).The operation time and hospital stay are shorter than those in the endoscopic group,but no Significant difference(t_(1)=1.189,P_(1)=0.221;t_(2)=3.604,P_(2)=0.326);the residual stone rate in the laparoscopic group was 6.67%(2/30)lower than that in the endoscopic group 13.33%(4/30),but there was no significant difference(χ^(2)=4.320,P=0.061);the complication rate in the laparoscopic group was 20%(6/30),which was higher than that in the endoscopic group 16.67%(5/30),but there was no significant difference(χ^(2)=0.647,P=0.421);After 1 year of follow-up,the recurrence rate of stones in the laparoscopic group was 10.00%(3/30),higher than that in the endoscopic group(3.33%(1/30)),but there was no significant difference(χ^(2)=2.588,P=0.108).Conclusion Compared with endoscopic sphincterotomy,laparoscopic common bile duct stone removal can significantly shorten the time of surgery,accelerate postoperative recovery and reduce stone residual,but has more blood loss during surgery,and the incidence of complications.The recurrence rate of stones is high.Compared with endoscopic stone removal,it has no advantage and still needs to determine the stone removal method according to the condition.