基于一体化手术平台的LC联合术中ERCP治疗胆囊结石合并胆总管结石的效果研究

Effect of LC combined with intraoperative ERCP in the treatment of cholecystolithiasis complicated with choledocholithiasis based on integrated surgical platform

目的探讨一体化手术平台中行腹腔镜胆囊切除术(LC)联合术中内镜逆行性胆胰管造影(ERCP)治疗胆囊结石合并胆总管结石的效果,并与序贯二步法ERCP+LC进行比较。方法回顾性分析2019年12月至2020年12月由台州医院和恩泽医院肝胆胰外科完成治疗的82例胆囊结石合并胆总管结石患者临床资料,其中在一体化手术平台完成LC联合术中ERCP治疗的37例患者分为A组,完成序贯二步法ERCP+LC治疗的45例患者分为B组,比较两组手术时间、术中出血量、结石清除率、疼痛评分、排气时间、下床活动时间、术后并发症发生率、住院时间、住院费用等指标的差异。结果两组术前基本资料比较无统计学差异,具有可比性(P>0.05)。两组在手术时间、术中出血量、结石清除率、术后疼痛评分、住院费用等方面无明显统计学差异(P>0.05)。A组术后排气时间[(16.0±4.5)h vs(19.9±6.0)h]、下床活动时间[(8.4±2.0)h vs(13.4±3.8)h]以及住院时间[(4.7±0.7)d vs(7.4±1.0)d]均明显短于B组(P<0.05)。两组患者在术后疼痛评分、住院费用方面无明显差异(P>0.05)。A组患者手术并发症总发生率[2.7%(1/37)vs 20.0%(9/45)]明显少于B组,差异有统计学意义(P<0.05)。结论在一体化手术平台行LC联合术中ERCP治疗胆囊结石合并胆总管结石较序贯二步法ERCP+LC效果更好,能缩短住院时间,减少手术并发症,且不增加住院费用,是一种较好的治疗手段。

Objective To investigate the effect of laparoscopic cholecystectomy(LC)combined with intraoperative endoscopic retrograde cholangiopancreatography(ERCP)on an integrated surgical platform,and sequential two-step ERCP+LC in the treatment of cholecystolithiasis combined with choledocholithiasis.Methods Clinical data of 82 patients with cholecystolithiasis and choledocholithiasis admitted in Taizhou Hospital and Enze Hospital between Dec.2019 and Dec.2020 were retrospectively analyzed.Among them,37 patients treated with LC combined with intraoperative ERCP on an integrated surgical platform were divided into Group A,and forty-five patients treated with sequential two-step ERCP+LC were divided into group B,the differences of operation time,intraoperative blood loss,stone clearance rate,pain score,time of exhaust and out of bed activity,postoperative complications incidence,hospitalization time and cost between the two groups were compared.Results There was no statistical difference in preoperative data between the two groups.There were no significant differences in operation time,intraoperative blood loss,stone clearance rate,postoperative pain score and hospitalization cost between the two groups(P>0.05).The postoperative time of exhaust[(16.0±4.5)h vs(19.9±6.0)h],time of out of bed activity[(8.4±2.0)h vs(13.4±3.8)h],and hospitalization time[(4.7±0.7)d vs(7.4±1.0)d]in group A were all significantly shorter than those in group B(P<0.05).There were no significant differences in postoperative pain score and hospitalization cost between the two groups(P>0.05).The total postoperative complication incidence in group A was significantly lower than that in group B[2.7%(1/37)vs 20.0%(9/45),P<0.05].Conclusion LC combined with intraoperative ERCP on an integrated surgical platform in the treatment of cholecystolithiasis combined with choledocholithiasis has better effect than the sequential two-step ERCP+LC,which can shorten the hospitalization time,reduce postoperative complications incidence,and do not increase the hospitalization cost.