腹腔镜下胆总管切开取石+一期胆道缝合与ERCP治疗胆总管结石疗效的对比分析

Comparative analysis of laparoscopic choledocholithotomy+primary biliary suture and ERCP in the treatment of choledo-cholithiasis

目的分析腹腔镜下胆总管切开取石+胆道镜探查+一期缝合术与ERCP+EST+ENBD术治疗单纯性胆总管结石的临床效果.方法回顾性分析安徽医科大学第一附属医院近3年来单纯性胆总管结石(不伴胆囊结石或肝内胆管结石)行手术治疗的56例病人的临床资料,其中行腹腔镜下胆总管切开取石+胆道镜探查+一期缝合术25例(观察组);ER-CP+EST+ENBD术31例(对照组).观察两组患者手术前后各实验室指标变化情况,如白细胞(WBC)、总胆红素指标(TBIL)、谷丙转氨酶(ALT)以及结石清除率、手术后并发症、结石复发等情况.结果两组患者术前结石直径、WBC、TBIL及ALT经对比分析后显示,两组资料均无统计学差别(P>0.05).手术后两组患者各实验室指标与术前相比,均有所降低;但手术后两组资料比较时并未发现存在统计学差异(P>0.05).两组患者住院天数和住院总费用比较差异有统计学意义(P<0.05).两组患者术后均无结石残留;观察组术后出现1例胆漏,对照组出现1例术后急性胰腺炎,随访对照组出现2例结石复发.结论腹腔镜下胆总管切开取石+胆道镜探查+一期缝合术与ERCP+EST+ENBD术治疗单纯性胆总管结石同样安全有效,但ERCP+EST+ENBD可能增加结石复发,结石较大或胆总管扩张明显时腹腔镜下胆总管切开取石+胆道镜探查+一期缝合更适合.

Objective To analyze the clinical effect of laparoscopic choledocholithotomy+choledochoscopy+primary suture and ERCP+EST+ENBD in the treatment of simple choledocholithiasis.Methods The clinical data of 56 patients with simple chole-docholithiasis(without cholecystolithiasis or hepatolithiasis)in the First Affiliated Hospital of Anhui Medical University in recent 3 years were retrospectively analyzed.Among them,25 cases underwent laparoscopic choledocholithotomy+choledochoscopy+primary suture(observation group);31 cases underwent ERCP+EST+ENBD(control group).The changes of laboratory indexes,such as white blood cell(WBC),total bilirubin(TBIL),alanine aminotransferase(ALT),stone clearance rate,postoperative complications and stone recurrence were observed before and after operation.Results there was no significant difference in stone diameter,WBC,TBIL and ALT between the two groups(P>0.05).After operation,the laboratory indexes of the two groups were decreased compared with those before operation,but there was no significant difference between the two groups after operation(P>0.05).There were significant differences in hospitalization days and total hospitalization expenses between the two groups(P<0.05).There were no residual stones in the two groups after operation;one case of bile leakage occurred in the observation group,and one case of postoperative acute pancreatitis occurred in the control group,and two cases of stone recurrence occurred in the control group during the follow-up.Conclusion Laparoscopic choledocholithotomy+choledochoscopy+primary suture and ERCP+EST+ENBD are equally safe and effective in the treatment of simple common bile duct stones,but ERCP+EST+ENBD may increase the recurrence of stones,and laparoscopic choledocholithotomy+choledochoscopy+primary suture ismore suitable when the stones are large or the common bile duct dilation is obvious.