胆囊结石合并胆总管结石的微创治疗体会

目的:比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)+LC治疗胆囊结石合并胆总管结石的临床疗效。方法:在2010年1月至2015年11月收治的胆囊结石合并胆总管结石患者中选取可耐受腹腔镜手术、ERCP且ASA分级为Ⅰ~Ⅱ级的成年患者作为研究对象,危急重症胆囊炎、急性胆管炎及要求保守治疗的患者未纳入研究。分为两组:LC+LCBDE组与ERCP/EST+LC组,比较分析两组患者术中出血量、手术时间、住院时间、住院费用及术后并发症等指标。结果:共纳入76例患者,30例行LC+LCBDE,其中2例中转开腹;46例行ERCP/EST+LC,其中2例因ERCP取石失败,不予统计。两组患者术中出血量、术后并发症差异无统计学意义,LC+LCBDE组手术时间、住院时间、住院费用优于ERCP/EST+LC组,差异有统计学意义。结论:两种术式治疗胆囊结石合并胆总管结石的疗效相当,但LC+LCBDE可能更加经济实惠。

Clinical trials of the efficiency of mini-invasive treatment for cholecystolithiasis and choledocholithiasis

Objective:To compare the clinical efficacy between laparoscopic cholecystectomy (LC)+laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST)+LC for cholecystolithiasis and choledocholithiasis.Methods:Patients who were diagnosed with gallbladder stones with common bile duct stones from Jan.2010 to Nov.2015 were selected,of whom the adult patients who were classified as ASA Ⅰ-Ⅱ and could tolerate abdominal surgery and ERCP were chosen as research objects.Patients who had critical cholecystitis,acute cholangitis or required conservative treatment were excluded.The patients were divided into two groups:the patients treated by LC+LCBDE were named as laparoscopic group and the patients treated by ERCP/EST+LC were named as endoscopic group.The indicators such as blood loss,operation time,hospital stay,hospitalization costs and postoperative complications were compared between the two groups.Results:Of the 76 included patients,30 cases belonged to laparoscopic group,in which 2 cases were not taken in to account for conversion to laparotomy;and 46 cases belonged to endoscopic group,of which 2 cases were excluded for conversion to laparotomy after failure of ERCP.There was no statistically significant difference in blood loss and postoperative complications in two groups.But the laparoscopic group was superior to endoscopic group in operation time,hospital stay as well as hospitalization costs,and the differences were statistically significant.Conclusions:The efficacy of LC+LCBDE vs.ERCP/EST+LC for gallbladder stones with common bile duct stone is equivalent,while the former one is much more affordable.