胆总管结石合并胆囊结石的两种不同处理方法的对比

【摘要】〓目的〓探讨胆总管结石合并胆囊结石的两种不同处理方法的优劣比较。方法〓我科自2008年1月至2013年3月共收治153例胆总管结石合并胆囊结石的病人,分别行内镜逆行胰胆管造影(ERCP)+腹腔镜胆囊切除术(LC)或腹腔镜胆道探查取石术(LCBDE)+LC术式治疗,并对手术时间、出血量、住院费用、术后血淀粉酶、结石残留率、术后并发症发生率等指标进行统计学分析。结果〓LCBDE+LC组平均手术时间、出血量分别为103.49±22.56 min、51.04±15.05 mL,均大于ERCP+LC组(87.89±18.33 min、16.84±6.58 mL,P<0.05),术后血淀粉酶及住院费用是LCBDE+LC组小于ERCP+LC组(86.23±16.58 U/L vs 303.31±46.32 U/L,21446±8739 元 vs 25419±8953元,P<0.05),LCBDE+LC组的术后并发症发生率明显低于ERCP+LC组(5.68% vs 14.29%),中转开腹率则是高于后者(5.68% vs 0),结石残留率无显著差别(2.27% vs 1.43%)。结论〓LCBDE+LC术式在术后血淀粉酶、并发症发生率、住院费用等方面较ERCP+LC为优,但在实际诊治中,应坚持个性化选择。

Comparison of two different methods for the management of cholecysto-choledocholithiasis

Objective To compare the clinical effects between two methods for the management of cholecysto-eholedocholithiasis. Methods From Jan 2008 to Mar 2013, a total of 153 cases of cholecysto-choledocholithiasis were treated by LCBDE （laparoscopic common bile duct exploration）＋ LC （ laparoscopic cholecystectomy ） or ERCP （ endoscopic retrograde cholangio-pancreatography ） ＋ LC. The surgical time, blood loss, postoperative blood amylase, total expenditure, stones clearance rate, complication rate were compared between two groups. Results LCBDE＋LC group showed better than the ERCP＋LC group in postoperative blood amylase, operation failure rate, complication rate and total expenditure （P〈0.05）. The latter showed better in surgery time, estimated blood loss （P〈0.05）. And there were no significant difference in stones clearance rate between the two groups （P〉0.05）. Conclusion In the present study, LCBDE＋LC group had more advantages than the ERCP＋LC group in postoperative blood amylase, operation failure rate, complication rate and total expenditure, while we should insist on personalization options in actual practice.