同期三镜联合手术与分期两镜手术治疗胆囊结石合并胆总管结石的疗效对比*

目的探讨同期三镜联合手术(腹腔镜+十二指肠镜+胆道镜)与分期两期两镜手术[内镜下逆行胰胆管造影(ERCP)+腹腔镜下胆囊切除术(LC)]治疗胆囊结石合并胆总管结石的疗效。方法回顾性分析2017年1月-2019年3月54例胆囊结石合并胆总管结石患者,分别行同期三镜手术和分期两镜手术,其中同期三镜手术29例,分期两镜手术25例,分析比较两组手术成功率、住院时间、住院费用、并发症和胆汁引流量等指标的差异。结果54例患者中,采取同期三镜手术患者均手术成功,无残余结石,无中转开腹,术后1例出现急性胰腺炎,1例出现梗阻性黄疸,转氨酶升高;采取分期两镜手术患者中,1例因十二指肠镜取石失败,改为择期同期三镜手术,其余手术均成功,结石完全被取出,术后轻症急性胰腺炎3例,1例出现电解质紊乱,1例行胆囊切除术后出现发热,1例出现黄疸。两组患者全麻术后肛门排气时间、住院总费用、术后第1天、第2天胆汁引流量比较,差异均无统计学意义(P>0.05),两组患者手术时间、术中出血量、住院时间和术后第3天胆汁引流量比较,差异均有统计学意义(P<0.05)。结论同期三镜手术较两期手术住院时间更短、术后恢复更快、并发症更少,但手术时间和出血量明显较分期两镜手术多。在合适的患者及其自身要求下,同期三镜手术可能会取得更好的治疗效果。

Comparison of three-endoscope and staged two-endoscope surgery for gallbladder stones combined with common bile duct stones*

Objective To compare the efficacy of three-endoscope combined surgery and two-stage surgery(endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy)in treatment of gallbladder stones combined with common bile duct stones.Methods A retrospective analysis was made of 54 patients with gallbladder stones combined with common bile duct stones from January 2017 to March 2019.They were divided into two groups.29 patients underwent three-endoscope surgery and 25 patients underwent staged two-endoscope surgery.The differences of the success rate,total hospitalization time,total hospitalization cost,complications and bile drainage volume between the two groups were analyzed and compared.Results Among the 54 cases,all the patients who underwent three-endoscope operation at the same time had successful operation,no residual stones,no conversion to open surgery,1 case of acute pancreatitis,1 case of obstructive jaundice and elevated aminotransferase,and 1 case of staged two-endoscope operation at different stages had failed to remove the stones by duodenoscopy and was replaced by three-endoscope operation at the same time.The rest of the operations were successful,the stones were completely removed and the postoperative mild symptoms were mild.There were 3 cases of acute pancreatitis,1 case of electrolyte disturbance,1 case of fever after cholecystectomy and 1 case of jaundice.There was no significant difference in anal exhaust time,total hospitalization cost,bile drainage volume on the first day and the second day after general anesthesia between the two groups(P>0.05).There were significant differences in operation time,intraoperative bleeding volume,hospitalization time and bile drainage volume on the third day after general anesthesia between the two groups(P<0.05).Conclusion In this study,three-endoscope surgery has shorter hospitalization time,quicker recovery and fewer complications than staged surgery,but the operation time and bleeding volume are obviously more than staged surgery.In appropriate cases and patients'own requirements,threeendoscope surgery at the same time may achieve better therapeutic effect.