ERCP+LC与LC+LCBDE治疗胆囊结石合并胆总管结石的疗效比较

目的比较腹腔镜联合十二指肠镜(ERCP+LC)与腹腔镜联合胆道镜(LC+LCBDE)两种微创术式治疗胆囊结石合并胆总管结石的疗效及安全性。方法回顾性分析2014年1月至2016年11月芜湖市第二人民医院收治的112例胆囊结石合并胆总管结石患者临床资料,其中ERCP+LC组62例和LC+LCBDE组50例,比较两组的手术成功率、一次性结石取净率、术后住院天数及并发症发生率等指标的差异。结果两组患者在性别、年龄、胆总管结石数等指标上均无统计学差异(P0.05),具有可比性。ERCP+LC组与LCBDE组在手术成功率(83.87%vs 90.00%)、术后住院天数[(7.86±3.41)d vs(6.31±2.95)d]、一次性结石取净率(98.3%vs 97.8%)、30 d内再入院率(3.4%vs 2.2%)相关指标上无统计学差异(P0.05),但ERCP+LC组术后总并发症发生率较LC+LCBDE组高(25.4%vs 11.1%,P=0.042);ERCP+LC组并发症主要包括高淀粉酶血症、急性胰腺炎、出血及感染,后者并发症则为胆漏、胃肠功能恢复欠佳及出血。结论腹腔镜联合十二指肠镜(ERCP+LC)与腹腔镜联合胆道镜(LC+LCBDE)这两种微创术式均是处理胆囊结石合并胆总管结石的安全、有效的方式,具体术式应根据患者个体情况及医院自身技术和设备条件合理选择。

Comparison of the curative effect of ERCP+LC and LC+LCBDE on gallbladder stones with common bile duct stones

Objective To compare the clinical effects and safety of ERCP+LC and LC+LCBDE in the treat-ment of gallbladder stones with common bile duct stones. Methods Clinical data of 112 cases of gallbladder stones with common bile duct stones treated with ERCP+LC (n=62) and LC+LCBDE (n=50) between Jan. 20l4 and Nov. 2016 were retrospectively analyzed. The success rate, duration of hospitalization, disposable stone clear-ance rate, postoperative complications were observed and compared between two groups. Results The two groups were comparable in respects of sex, age, number of common bile duct stones and so on. Between ERCP+LC group and LC+LCBDE group, there was no significant difference in terms of the success rate (83.87% vs 90.00%), duration of hospitalization [(7.86±3.41) d vs (6.31±2.95) d], disposable stone clearance rate (98.3% vs 97.8%), and re-admission rate within 30 d (3.4% vs 2.2%). However, the total complication rate in ERCP+LC group was higher than that of LC+LCBDE group (25.4% vs 11.1%, P=0.042). The main postoperative complica-tions were hyperamylasemia, acute pancreatitis, bleeding, biliary and infection in ERCP+LC group; whereas bile leakage, poor recovery of gastrointestinal function and bleeding were found in LC+LCBDE group. Conclusion Both ERCP+LC and LC+LCBDE are safe and effective for the treatment of gallbladder stones with common bile duct stones. Both of which can be selected depending on the individual condition of the patient and the skill and equipment conditions.