同期腹腔镜胆囊切除联合腹腔镜胆总管探查术或内镜括约肌切开取石术治疗胆囊结石合并胆总管结石的疗效比较

Synchronous laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration or combined with endoscopic sphincterotomy for gallstones with common bile duct stones

目的探讨同期腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)(LC+LCBDE)或同期LC联合术中内镜下十二指肠乳头括约肌切开术(intraoperative endoscopic sphincterotomy,IO-EST)(LC+IO-EST)治疗胆囊结石合并胆总管结石的疗效。方法回顾性分析2013年4月至2020年4月扬州大学临床医学院收治的903例胆囊结石合并胆总管结石患者的临床资料。结果根据手术方案不同,将其分为A组(LC+LCBDE)389例和B组(LC+IO-EST)514例。A组患者的胆总管结石复发率、再复发率显著低于B组患者(4.4%比8.4%,P=0.024;0.8%比3.1%,P=0.010)。通过逆概率加权后的逻辑回归分析显示,A组手术方案是胆总管结石复发和再复发的独立保护因素(OR=0.482,95%CI:0.365~0.637,P<0.001;OR=0.118,95%CI:0.080~0.173,P<0.001)。结论对于胆囊结石合并胆总管结石且胆总管直径≥8 mm的患者,LC+LCBDE相较于LC+IO-EST是更优选的治疗方案。

Objective To compare the recurrence of common bile duct stones(CBDS)in patients with gallstones and concurrent CBDS treated by two surgical approaches:synchronous laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE)(LC+LCBDE)and synchronous LC combined with intraoperative endoscopic sphincterotomy(IO-EST)(LC+IO-EST).Methods From Apr 2013 to Apr 2020,the clinical data of 903 patients with gallstones with CBDS who were admitted to the Clinical Medical College,Yangzhou University were retrospectively analyzed.Results Based on the chosen surgical method,we categorized 389 cases into group A(LC+LCBDE)and 514 cases into group B(LC+IO-EST).Our findings revealed that group A had a significantly lower rate of CBDS recurrence and re-recurrent CBDS compared to group B(4.4%vs.8.4%,P=0.024;0.8%vs.3.1%,P=0.010).Moreover,Logistic regression analysis after inverse probability of treatment weighting,revealed that the surgical approach implemented in group A was an independent protective factor of recurrent CBDS and second recurrence of CBDS(OR=0.482,95%CI:0.365-0.637,P<0.001;OR=0.118,95%CI:0.080-0.173,P<0.001).Conclusion LC+LCBDE is an optimal treatment option to LC+IO-EST for patients with gallstones combined with CBDS and common bile duct≥8 mm.