LCBDE与ERCP/EST治疗胆囊切除术后胆总管结石的疗效对比

Comparison of the efficacy of LCBDE and ERCP/EST in the treatment of common bile duct stones after cholecystectomy

目的通过比较腹腔镜下胆总管探查术(LCBDE)与内镜下逆行胰胆管造影(ERCP)+括约肌切开取石术(EST)治疗胆囊切除术后胆总管结石的疗效,提供此类型胆总管结石的临床治疗思路。方法回顾性分析本院2017年1—12月80例胆囊切除术后胆总管结石患者临床资料,其中采取腹腔镜下胆总管探查术(LCBDE)患者40例,ERCP/EST取石术患者40例,比较两种手术方式治疗胆总管结石的取石成功率,手术时间、术中出血、术后淀粉酶、平均住院时间、术后并发症等指标。结果两组患者性别、年龄、合并基础疾病等术前相关指标无统计学差异(P>0.05),具有可比性。LCBDE组与ERCP/EST组患者取石成功率(95.0%VS 85.0%),术中出血[(32.25±6.40) ml VS(28.75±5.03) ml]等比较无统计学意义(P>0.05); ERCP/EST组在手术时间[(52.75±16.28) min VS (145±48.18) min]及平均住院时间[(8.65±2.37) d VS(12.68±3.37) d]上要优于LCBDE组(P<0.05),但ERCP/EST组术后淀粉酶[(128.15±85.10) U/L VS(263.83±142.96) U/L]要高于LCBDE组,且手术总体并发症要高于LCBDE组(42.5%VS 10.0%,P<0.05)。结论两组手术方式均能够有效治疗胆总管结石,选择哪种手术方式需要根据患者自身具体情况而定。

Objective To compare the efficiency of laparoscopic common bile duct exploration( LCBDE) and the combination of endoscopic retrograde cholangiopancreatography( ERCP) and endoscopic sphincterotomy( EST) for treating common bile duct stones after cholecystectomy,providing clinical treatment ideas for this type of common bile duct stones. Methods Clinical data of 80 cases of common duct bile stones after cholecystectomy treated with LCBDE( n = 40) and ERCP/EST( n = 40) between Jan. 2017 and Dec. 2017 were retrospectively analyzed. The success rate,operative time,intra-operative bleeding,postoperative amylase level,the average of hospital stay,postoperative complications were observed and compared between the two groups.Results The two groups were comparable in respect of sex,age,associated with basic diseases and so on.Between LCBDE group and ERCP/EST group,there was no significant difference in terms of the success rate( 95.0% VS 85.0%),intra-operative bleeding( 32.25±6.40 ml VS 28.75±5.03 ml),P>0.05. ERCP/EST group had shorter operative time( 52.75±16.28 min VS 145±48.18 min and the average length of hospital stay( 8.65±2.37 d VS12.68±3.37 d) than LCBDE group( P<0.05),the postoperative amylase level( 128.15±85.10 U/L VS 263.83±142.96 U/L) of ERCP/EST group was higher than that of LCBDE group,and the total complication rate in ERCP/EST group was higher than that of LCBDE group( 42. 5% VS 10. 0%,P < 0. 05). Conclusions Both of LCBDE and ERCP/EST are effective for the treatment of common duct bile stones after cholecystectomy,which can be selected depending on the individual condition of the patients.