不同腹腔镜手术治疗胆囊结石合并胆总管结石的疗效及并发症对比

Comparison of the efficacy and complications of different laparoscopic operations for cholecystolithiasis combined with choledocholithiasis

目的研究“一步法”与序贯“二步法”腹腔镜手术治疗胆囊结石合并胆总管结石患者的整体疗效及术后并发症对比。方法纳入2020年5月至2022年5月期间收治的103例胆囊结石合并胆总管结石患者,根据治疗方法将其分为一步法组(n=48)与二步法组(n=55),一步法组实施腹腔镜胆总管探查术(LCBDE)联合腹腔镜胆囊切除术(LC)治疗;二步法组实施内镜逆行胰胆管造影(ERCP)与内镜十二指肠乳头括约肌切开取石术(EST)联合LC治疗。将所有患者数据进行倾向性匹配评分(卡钳值为0.02)排除基线资料混杂因素影响,两组各获得46例基线资料可比的患者。数据采用SSPS 24.0软件分析,计数资料以[例(%)]表示,采用χ^(2)检验;计量资料以x±s表示,采用配对t检验或者LSD-t检验。P<0.05表示差异有统计学意义。结果两组患者手术期间一次性结石清除率(93.5% vs. 91.3%)、中转开腹率(0.0% vs. 2.2%)、结石残留率(6.5% vs. 8.7%)比及胃肠道功能比较,差异均无统计学意义(P>0.05),两组患者术后胃肠道功能改善用时比较差异无统计学意义(P>0.05);一步法组镇静剂使用率及住院时间均显著低于二步法组(P<0.05);两组患者手术期间并发症发生率(8.7% vs. 10.9%),差异无统计学意义(P>0.05)。结论LCBDE联合LC治疗胆囊结石合并胆总管结石,术后恢复更快,适用于年轻患者或结石较大患者,但对于老年患者或重度梗阻性黄疽患者,则可以采选ERCP/EST+LC治疗,因此临床应根据患者实际情况选择合适的微创治疗方案。

Objective To study the overall efficacy and postoperative complications of "one-step" and sequential "two-step" laparoscopic surgery for cholecystolithiasis combined with choledocholithiasis.Methods A total of 103 patients with calculi admitted from May 2020 to May 2022 were included and divided into one-step group (n=48) and two-step group (n=55) according to treatment methods. The one-step group was treated with laparoscopic choledochotomy (LCBDE) combined with laparoscopic cholecystectomy (LC). In the two-step group, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic duodenal papillary sphincterotomy (EST) combined with LC were performed. All patients' data were scored by propensity matching (caliper value: 0.02) to exclude the influence of confounding factors of baseline data, and 46 patients with comparable baseline data were obtained in each group. The data were analyzed using SSPS 24.0 software, and the statistical data were expressed as [n (%)] and χ^(2) test was used. Measurement data were expressed as x±s using paired t test or LSD-t test. P<0.05 indicated that the difference was statistically significant.Results There was no significant difference in one-time stone clearance rate (93.5% vs. 91.3%), conversion to laparotomy rate (0.0% vs. 2.2%), stone residual rate (6.5% vs. 8.7%) and gastrointestinal function between the two groups during operation (P>0.05). There was no significant difference in the improvement time of gastrointestinal function between the two groups (P>0.05). The rate of sedative use and length of hospital stay in one-step group were significantly lower than those in two-step group (P<0.05). There was no significant difference in the incidence of complications during operation between the two groups (8.7% vs. 10.9%) (P>0.05).Conclusion LCBDE combined with LC in the treatment of cholecystolithiasis combined with choledocholithiasis has a faster postoperative recovery, which is suitable for young patients or patients with large stones, but ERCP/EST+LC can be selected for elderly patients or patients with severe obstructive gangrene. Therefore, the appropriate minimally invasive treatment plan should be selected according to the actual situation of patients.