腹腔镜胆总管探查取石术与内镜取石术治疗结石性急性轻中度胆管炎的对比研究

目的:观察腹腔镜胆总管探查取石术(LCBDE)与内镜下逆胆胰管造影胆总管取石术(ERCP)治疗结石性急性轻中度胆管炎的疗效。方法:回顾性分析沧州市人民医院2017年1月—2018年12月收治的111例结石性急性轻中度胆管炎患者的病历资料,按照手术方式将其分为双镜组(n=41)和内镜组(n=70)。双镜组采用腹腔镜联合胆道镜胆总管探查取石术,内镜组采用ERCP及乳头括约肌切开术(EST)、十二指肠乳头气囊扩张术(EPBD)、网篮或球囊取石术。记录两组手术时间、住院时间、住院费用、术后排气时间、术后并发症发生率(LCBDE并发症包括胆漏、切口感染、胆道出血等,ERCP并发症包括一过性淀粉酶升高、胰腺炎、胆道出血等)、一次性结石取净率、术后6个月结石复发率等指标,比较两种术式的治疗效果及术后并发症的差异。结果:两组均手术顺利,双镜组无中转开腹病例,内镜组有1例因胆道严重出血中转开腹。双镜组手术时间为(103.20±35.80)min,内镜组为(105.60±29.88)min,两组差异无统计学意义(P>0.05),双镜组的住院时间长于内镜组(12.78±2.73)d vs.(11.36±2.65)d],差异有统计学意义(P<0.05)。双镜组的住院费用低于内镜组(2.64±0.45)万元vs.(3.15±0.62)万元],差异有统计学意义(P<0.05)。双镜组的术后排气时间早于内镜组(2.35±0.85)d vs.(3.24±0.90)d],两组差异有统计学意义(P<0.05)。一次性结石取净率双镜组为100%,内镜组为94.3%、术后并发症发生率双镜组为2.0%,内镜组为8.5%。术后6个月结石复发率双镜组为0,内镜组为1.4%。两组的上述并发症发生率差异均无统计学意义(P>0.05)。结论:LCBDE治疗结石性急性轻中度胆管炎时可以使患者住院费用减少、术后排气时间缩短,而ERCP可以使患者住院时间缩短,临床上应依据实际情况选择相应的术式。

Comparative Study on Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cannulation of Pancreatic in Treatment of Acute Mild to Moderate Cholangitis

Objective To investigate the efficacy of laparoscopic common bile duct exploration(LCBDE)and endoscopic retrograde cannulation of pancreatic(ERCP)in the treatment of acute mild and moderate cholangitis caused by calculi.Methods The medical records of 111 patients with calculous acute mild to moderate cholangitis admitted to Cangzhou People’s Hospital from January 2017 to December 2018 were retrospectively analyzed.The patients were divided into two groups according to the surgical methods,such as double-mirror group(n=41)and endoscopy group(n=70).Laparoscopy combined with choledochoscopic common bile duct exploration and lithotripsy was performed in the double-mirror group.ERCP,endoscopic sphincterotomy(EST),endoscopic papillary balloon dilation(EPBD),basket or balloon lithotripsy were performed in the endoscopic group.The operation time,hospitalization time,hospitalization expenses,postoperative exhaust time,incidence of complications(LCBDE complications including bile leakage,incision infection,biliary tract hemorrhage,ERCP complications including transient amylase elevation,pancreatitis,biliary tract hemorrhage,etc.),rate of one-time stone clearance rate,and recurrence in 6 months after operation were recorded.The difference of therapeutic effect between the two kinds of operation was compared by statistical analysis.Results The operation was successful in both groups.There was no case of conversion to open surgery in double-mirror group.One case in endoscopy group was converted to open surgery due to severe bleeding of the biliary tract.The operation time of double-mirror group was(103.20±35.80)min,and that of the endoscopy group was(105.60±29.88)min.There was no significant difference in the operation time between the two groups(P>0.05).The hospitalization time was(12.78±2.73)d and(11.36±2.65)d,the difference was statistically significant(P<0.05),and the endoscopy group was shorter in hospitalization time.The hospitalization expenses of the double-mirror group and endoscopy group were(2.64±0.45)ten thousand Yuan and(3.15±0.62)ten thousand Yuan,respectively.There was a statistically significant difference(P<0.05),and the double-mirror group had less hospitalization costs.The postoperative exhaust time of the two groups was(2.35±0.85)d and(3.24±0.90)d,respectively.The difference between the two groups was statistically significant(P<0.05).The exhaust time of the double-mirror group was faster.The rate of one-time stone removal was 100%in double?mirror group and 94.3%in endoscopy group,and the rate of postoperative complications was 2.0%in double?mirror group and 8.5%in endoscopy group.The recurrence rate of stones in 6 months after surgery was 0 in double-mirror group and 1.4%in endoscopy group.There was no significant difference in the comparison between the two groups(P>0.05).Conclusion LCBDE can reduce the cost of hospitalization and shorten the exhaust time after treatment of calculus in patients with acute mild to moderate cholangitis.ERCP can shorten the length of hospital stay.Clinically,the corresponding procedure should be selected according to the actual situation.