ERCP联合LC同期手术在治疗老年胆囊胆总管结石的临床研究

Clinical study of ERCP combined with LC simultaneous surgery in the treatment of elderly patients with gallbladder and common bile duct stones

目的探讨内镜逆行胰胆管造影(ERCP)联合腹腔镜胆囊切除术(LC)同期手术在治疗老年胆囊结石合并胆总管结石患者中的疗效及临床意义。方法去回顾我院2019年8月至2023年月12收治的86例老年胆囊结石合并胆总管结石病例资料,均采用ERCP联合LC手术治疗,依据不同手术方式分为ERCP联合LC同期手术(A组)及ERCP术后3~5天序贯LC(B组)两组,比较两种治疗方式的手术时间、取石成功率、术后并发症发生率、住院时间、治疗费用等。结果A组40例患者均手术成功,ERCP平均时间37min,LC平均时间41min,平均住院时间9d,平均住院费用3.6万;ERCP术后并发症4例:急性胰腺炎3例、胆管炎0例、十二指肠乳头出血1例、十二指肠穿孔0例。B组46例患者均手术成功ERCP平均时间39min,LC平均时间46min,差异无统计学意义(P>0.05)。平均住院时间12d,平均住院费用约4万,差异有统计学意义(P<0.05)。ERCP术后并发症5例:急性胰腺炎3例、胆管炎1例、十二指肠乳头出血1例、十二指肠穿孔0例,与A组差异无统计学意义(P>0.05)。结论在合理选择患者的前提下,ERCP联合LC同期手术微创治疗胆囊合并胆总管结石在老年患者中是安全可行的,与分期序贯手术相比具有住院时间短及总体住院费用下降,且不增加并发症发生率的优势;与腹腔镜胆囊切除、胆总管切开取石及T管引流(LCBDE)相比,增加了患者术后舒适度,维持了胆总管完整性,值得推广。

Objective To explore the efficacy and clinical significance of endoscopic retrograde cholangiopancreatography(ERCP)combined with laparoscopic cholecystectomy(LC)in the treatment of elderly patients with gallstones and common bile duct stones.Method A retrospective study was conducted on 86 elderly patients with gallbladder stones and common bile duct stones admitted to our hospital from August 2019 to December 2023.All patients underwent ERCP combined with LC surgery,and were divided into two groups based on different surgical methods:ERCP combined with LC simultaneous surgery(Group A)and ERCP sequential LC 3~5 days after surgery(Group B).The surgical time,stone removal success rate,incidence of postoperative complications,hospital stay,and treatment costs of the two treatment methods were compared.The results showed that all 40 patients in Group A had successful surgery,with an average ERCP time of 37 minutes,an average LC time of 41 minutes,an average hospital stay of9 days,and an average hospitalization cost of 36000 yuan;There were 4 postoperative complications of ERCP:3 cases of acute pancreatitis,0 cases of cholangitis,1 case of duodenal papillary hemorrhage,and O cases of duodenal perforation.The average time for successful ERCP and LC in Group B of 46 patients was 39 minutes and 46 minutes respectively,with no statistically significant difference(P>0.05).The average hospitalization time is 12 days,and the average hospitalization cost is about 40000 yuan,with a statistically significant difference(P<0.05).There were 5 postoperative complications of ERCP,including 3 cases of acute pancreatitis,1 case of cholangitis,1 case of duodenal papillary bleeding,and O cases of duodenal perforation.There was no statistically significant difference compared to Group A(P>0.05).Conclusion:Under the premise of reasonable patient selection,ERCP combined with LC simultaneous minimally invasive surgery is safe and feasible for the treatment of gallbladder combined with common bile duct stones in elderly patients.Compared with staged sequential surgery,it has the advantages of shorter hospital stay,lower overall hospitalization costs,and no increase in the incidence of complications;Compared with laparoscopic cholecystectomy,common bile duct incision for stone removal,and T-tube drainage(LCBDE),it increases patient postoperative comfort and maintains the integrity of the common bile duct,which is worth promoting.