腹腔镜胆总管切开取石与ERCP对胆管结石合并胆囊结石患者术后恢复及远期随访结果的影响

Effect of Laparoscopic Choledocholithotomy and Ercp on Postoperative Recovery and Long-Term Follow-Up of Patients with Bile Duct Stones Complicated with Gallbladder Stones

目的:对比腹腔镜胆总管切开取石术与经内镜逆行胰胆管造影术(ERCP)对胆管结石合并胆囊结石患者术后恢复及远期随访结果的影响。方法:将本院2019年5月至2022年5月收治的128例胆管结石合并胆囊结石患者依据手术方式分为腹腔镜组(n=66,腹腔镜胆总管切开取石术)和ERCP组(n=62,ERCP术)。对比两组的一次手术成功率、手术时间、术中出血量、温氏孔/鼻胆管引流时间;比较两组的术后首次排气时间、下地活动时间、住院时间、住院费用。对比两组术后并发症,观察两组术后2年的结石复发率。结果:腹腔镜组的一次手术成功率高于ERCP组,手术时间、术中出血量高于ERCP组,温氏孔/鼻胆管引流时间短于ERCP组(P<0.05);腹腔镜组的术后首次排气时间、下地活动时间、术后住院时间相较于ERCP组缩短,住院费用相较于ERCP组增加(P<0.05);两组的术后并发症情况比较差异不明显(P>0.05);术后2年内,腹腔镜组的结石复发率明显低于ERCP组(P<0.05)。结论:对胆管结石合并胆囊结石患者应用腹腔镜胆总管切开取石术与ERCP均可取得明显的效果,其中腹腔镜胆总管切开取石术相比于ERCP术的术后恢复较快,远期复发率低,但手术费用较高。

Objective:To compare the influence of laparoscopic choledocholithotomy and ERCP(endoscopic retrograde cholangiopancreatography)on postoperative recovery and long-term follow-up outcome in patients with bile duct stones(BDS)and gallbladder stones(GBS).Methods:Totally 128 BDS patients with GBS in the hospital from May 2019 to May 2022 were divided into laparoscopic group(n=66,laparoscopic choledocholithotomy)and ERCP group(n=62,ERCP)by means of the surgical methods.The success rate of one surgery,surgical time,intraoperative blood loss,Winslow foramen/nasobiliary drainage time,postoperative first exhaust time,ambulation time,hospitalization time and cost and postoperative complications were compared between groups,and the stone recurrence rate in both groups was observed at 2 years after surgery.Results:The success rate of one surgery in the laparoscopic group was higher than that in the ERCP group,and the surgical time and intraoperative blood loss were longer or more than those in the ERCP group while the Winslow foramen/nasobiliary drainage time was shorter(P<0.05).Compared with the ERCP group,the postoperative first exhaust time,ambulation time and postoperative hospitalization time were shortened in the laparoscopic group,and the hospitalization cost was increased(P<0.05).The postoperative complications revealed no obvious differences between groups(P>0.05).The stone recurrence rate in the laparoscopic group within 2 years after surgery was obviously lower than that in the ERCP group(P<0.05).Conclusion:Laparoscopic choledocholithotomy and ERCP can achieve significant results in the treatment of patients with bile duct stones and gallbladder stones.Compared with ERCP,laparoscopic choledocholithotomy has faster postoperative recovery and lower long-term recurrence rate,but has higher surgical cost.