ERCP+LC和LCBDE+LC+T管引流治疗胆总管结石合并胆囊结石的临床分析

目的:比较内镜逆行胰胆管造影（ERCP）联合腹腔镜胆囊切除术（LC）与腹腔镜胆总管切开胆道镜探查取石术（LCBDE）联合LC联合T管引流治疗胆总管结石合并胆囊结石的临床疗效。方法:回顾性分析64例胆总管结石合并胆囊结石患者的临床治疗，按照术式不同分为ERCP+LC组（n=34）和LCBDE+LC+T管引流组（n=30），比较两组患者的手术总用时、术中出血量、净石率以及取石成功率、术后并发症、住院时间、住院费用、手术满意度、术前、术后3个月以及术后6个月生活质量等指标。结果:两组患者的取石成功率、净石率、术后并发症、患者对手术的满意度以及手术前、手术后3个月、手术后6个月的生活质量平均分的差异无统计学意义（P>0.05），但ERCP+LC组的手术总用时和术中出血量均显著少于LCBDE+LC+T管引流组（P<0.05），ERCP+LC组的总住院时间比LCBDE+LC+T管引流组少37.7%（P<0.05），而其总住院费用却高出24.6%（P<0.05）。结论:ERCP+LC和LCBDE+LC+T管引流这两种微创手术均是治疗胆总管结石合并胆囊结石的有效途径，具有较好的安全性，但具体的手术方案要结合各医院的设备以及患者个体情况进行选择。

Clinical analysis of ERCP+LC and LCBDE+LC+T tube drainage in the treatment of choledocholithiasis complicated with cholecystolithiasis

Abstract: Objective To compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) versus laparoscopic common bile duct exploration (LCBDE) combined with LC drainage and T tube drainage in the treatment of choledocholithiasis complicated with cholecystolithiasis. Methods According to the surgical procedures, 64 patients with choledocholithiasis complicated with cholecystolithiasis were retrospectively divided into ERCP+LC group (n=34) and LCBDE+LC+T tube drainage group (n=30). The total operation time, intraoperative blood loss, stone removal rate, stone removal success rate, postoperative complications, hospital stay, hospital expenses, satisfaction with the surgery, and quality of life before surgery and in 3 and 6 months postoperatively were compared between two groups. Results There were no significant differences between two groups in stone removal success rate, stone removal rate, postoperative complications, satisfaction with the surgery, quality of life before operation and in 3 and 6 months postoperatively (P>0.05). The total operation time and intraoperative blood loss in ERCP+LC group were significantly less than those in LCBDE+LC+T tube drainage group (P<0.05). The total hospital stay in ERCP+LC group was 37.7% shorter than that in LCBDE+LC+T tube drainage group (P<0.05), but the total hospitalization cost was 24.6% higher (P<0.05). Conclusion Both minimally invasive procedures of ERCP+LC and LCBDE+LC+T tube drainage are effective and safe in the treatment of choledocholithiasis complicated with cholecystolithiasis, but the concrete surgical procedure should be determined based on the comprehensive consideration of the equipments in hospital and the individual situation of patients.