EST与LCBDE在肝外胆管结石患者中的效果分析

Effect of EST and LCBDE in patients with extrahepatic cholangiolithiasis

目的比较内镜下括约肌切开取石术(endoscopic sphincterotomy,EST)和腹腔镜胆总管探查取石术(laparscop-ic common bile duct exploration,LCBDE)在治疗肝外胆管结石中的安全性和有效性。方法回顾性分析合肥市第二人民医院2018至2022年间176例肝外胆管结石患者的临床资料,根据患者采取的治疗方式,将患者分为EST组和LCBDE组。比较两组患者基线资料及手术时间、术中出血量、住院费用和术后并发症发生率的差异。结果两组患者在年龄、性别、体重指数、ASA分级及人院主诉方面无明显差异,采用EST治疗的患者术前行MRCP进行确诊的占比例更高(69.3%对53.45%,P=0.03)。EST组患者在手术时间、术中出血量.住院天数及住院费用分别为(77.81±15.02)min.(24.95±5.64)ml.(5.32±2.29)天.(2.92±0.65)万元,LCBDE组相应为(111.17±14.40)min.(30.75±6.83)ml.(8.66±2.13)天.(3.69±1.23)万元,两组比较差异有统计学意义(P均<0.001)。EST组术后发生出血患者4例,延迟性穿孔1例,胰腺炎6例,胆管炎4例;LCBDE组患者术后发生出血2例,胰腺炎4例,胆管炎3例,胆漏3例,伤口感染3例,肺炎3例,两组比较无统计学差异(P>0.05)。两组残余结石率分别为2.3%和10.2%(P=0.029),两组患者均未发生围手术期死亡。结论EST与LCBDE在治疗肝外胆管结石中均安全有效,并发症发生情况相当,但是EST作为更微创的手术方式,不需要全身麻醉,手术时间更短,术中出血量低,患者住院时间更短,费用也更低。

Objective To compare the safety and eficacy of endoscopic sphincterotomy(EST)and laparoscopice common bile duct exploration(LCBDE)in the treatment of extrahepatic bile duct stones.Methods The clinical data of 176 patients with extrahe-patic bile duct stones were retrospectively analyzed in the Second Peoples Hospital of Hefei from 2018 to 2022.They were divided into EST group and LCBDE group according to their treatment methods.The baseline data,operative time,intraoperative blood loss,hospi-tal expenses and incidence of postoperative complications of the two groups were compared.Results There were no significant differ-ences between the two groups in age,gender,body mass index,ASA grade,and chief complaint of admission.Among the patients re-ceiving EST,the proportion of preoperative MRCP diagnosis was higher(69.3%us 53.45%,P=0.03).The operation time,intraop-erative blood loss,hospitalization days and hospitalization expenses of the EST group were(77.81±15.02)min,(24.95+5.64)ml,(5.32±2.29)days and(29200±6500)RMB,respectively.The corresponding values of the LCBDE group were(111.17±14.40)min,(30.75±6.83)ml,(8.66±2.13)days,and 36900±12300)RMB,with staistically significant differences between the two groups(all P<0.001).In the EST group,there were 4 cases with postoperative bleeding,1 case of delayed perforation,6 ca-ses of pancreatitis and 4 cases of biliary ductitis;in the LCBDE group,there were 2 patients with postoperative bleeding,4 cases of pancreatitis,3 cases of biliary ductitis,3 cases of bile leakage,3 cases of wound infection and 3 cases of pneumonia,with no statisti-cal dfference between the two groups(P>0.05).The residual stone rates in the two groups were2.3%and 10.2%(P=0.029),respectively.No perioperative death occrred in either group.Conclusions Both EST and LCBDE are safe and effective in the treat-ment of extrahepatic bile duct stones with comparable complications,but EST,being a more minimally invasive procedure,does not re-quire general anaesthesia,having a shorter operative time,lower intraoperative bleeding,a shorter patient stay and lower costs.