LCBDE+PDC与ERCP治疗胆囊切除术后肝外胆管结石效果比较

Comparison of LCBDE+PDC and ERCP in the treatment of extrahepatic cholangiolithiasis after cholecystectomy

目的探讨腹腔镜下胆总管探查并一期缝合术(LCBDE+PDC)与经内镜逆行胰胆管造影术(ERCP)在治疗胆囊切除术后肝外胆管结石的临床价值。方法回顾性分析2016年7月至2020年11月期间上海市徐汇区中心医院收治的胆囊切除术后肝外胆管结石患者的临床资料。根据手术方式分为腹腔镜下胆总管探查并一期缝合术治疗组(LCBDE+PDC组,n=22)和经内镜逆行胰胆管造影术组(ERCP组,n=45),比较两组患者的手术相关指标及术后指标。结果两组患者基线资料如性别、年龄、BMI、结石数目、结石长径、WBC、TBIL、DBIL、ALT比较无统计学差异(P>0.05)。两组患者经过治疗后结石清除率、术后并发症发生率无统计学差异(P>0.05);两组患者术后第1天TBIL、DBIL、ALT比较无统计学差异(P>0.05)。与LCBDE+PDC组相比,ERCP组手术时间更短[(26.58±6.59)min vs(79.95±9.95)min]、术后肛门通气时间更短[(14.18±1.64)h vs(21.59±3.53)h],术后第1天WBC更低,均有统计学差异(P<0.05)。结论对于胆囊切除术后肝外胆管结石数量≤2枚及结石长径≤15 mm的患者,采用LCBDE+PDC与ERCP治疗的效果未见明显差异,但ERCP治疗较LCBDE+PDC在总手术时间、术后恢复等方面更有优势。

Objective To explore the clinical value of laparoscopic common bile duct exploration+primary duct closure(LCBDE+PDC)and endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of extrahepatic cholangiolithiasis after cholecystectomy.Methods The clinical data of patients with extrahepatic cholangiolithiasis after cholecystectomy admitted to Central Hospital of Xuhui District in Shanghai from Jul.2016 to Nov.2020 were retrospectively analyzed.The patients were divided into LCBDE+PDC group(n=22)and ERCP group(n=45).Results There were no significant differences in baseline datas such as gender,age,body mass index number of stones,maximum diameter of stones,WBC,TBIL,DBIL or ALT between the two groups(P>0.05).There were no significant differences in stone clearance rate and incidencerate of postoperative complications between the two groups(P>0.05).There were no significant differences in TBIL,DBIL or ALT between the two groups on the first day after operation(P>0.05).Compared with the LCBDE+PDC group,the operation time was shorter[(26.58±6.59)min vs(79.95±9.95)min],postoperative ventilation time was shorter[(14.18±1.64)h vs(21.59±3.53)h]in ERCP group(P<0.05),the WBC in the ERCP group was significantly lower on the first day after operation(P<0.001).Conclusion LCBDE+PDC and ERCP are both safe and effective for patients with the number of extrahepatic bile duct stones≤2 and the maximum stone diameter≤15 mm after cholecystectomy,but ERCP treatment has certain advantages in shorter operation time and betterrecovery of intestinal function.