两种微创术式治疗胆囊结石合并胆总管结石临床疗效的比较

目的:比较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)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与LC+腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)治疗胆囊结石合并胆总管结石的临床疗效及安全性。方法:回顾分析2013年1月至2014年8月收治的胆囊结石合并胆总管结石患者的临床资料,87例行ERCP/EST+LC(A组),71例行LC+LCBDE(B组)。结果:两组首次手术成功率(94.25%vs.92.96%,P=0.452)、中转开腹率(5.75%vs.7.04%,P=0.452)及术后并发症发生率(3.45%vs.2.82%,P=0.168)差异均无统计学意义,但B组手术时间(105.7±9.2)min vs.(132.4±15.1)min,P=0.012]、住院时间(5.5±2.8)d vs.(6.9±3.4)d,P=0.008]、住院费用(5 347.1±672.1)元vs.(7 923.5±657.2)元,P=0.002]均少于A组。短期随访发现两组结石清除率无明显差别(97.7%vs.100%,P=0.219)。结论:ERCP/EST+LC、LC+LCBDE治疗胆囊结石合并胆总管结石同样安全、有效,LC+LCBDE在手术时间、住院时间及住院费用方面更具优势。因此,对于适当的病例,LC+LCBDE可作为首选的治疗方法。

Clinical comparative analysis on two kinds of minimally invasive treatment for cholecystolithiasis combined with choledocholi-thiasis

Objective:To compare the therapeutic effects and safety of endoscopic retrograde cholangiopancreatography ( ER-CP)/endoscopic sphincterotomy ( EST) plus laparoscopic cholecystectomy ( LC) and LC plus laparoscopic common bile duct explora-tion ( LCBDE) for cholecystolithiasis combined with choledocholithiasis .Methods:The clinical data of cholecystolithiasis with choledo-cholithiasis patients from Jan.2013 to Aug.2014 were analyzed retrospectively.During this period,87 patients were treated by ERCP/EST+LC and 71 patients by LC +LCBDE.Results:There were no statistically significant differences in the age ,gender,number of stones,stone diameter and common bile duct diameter in two groups (P>0.05).No significant differences were observed in terms of operation success rate (94.25%vs.92.96%,P=0.452),conversion to open surgery rate (5.75%vs.7.04%,P=0.452) and inci-dence of postoperative complication (3.45%vs.2.82%,P=0.168) in two groups.However,operation time (105.7 ±9.2) min vs. (132.4 ±15.1) min,P=0.012] and hospital stay (5.5 ±2.8) d vs.(6.9 ±3.4) d,P=0.008] were shorter in LC +LCBDE group than those in ERCP/EST+LC group,and hospitalization charges in LC +LCBDE group were less than that in ERCP/EST+LC group (5 347.1 ±672.1) yuan vs.(7 923.5 ±657.2) yuan,P=0.002].The results of short-term follow-up suggested that the clear-ance rate of calculus in two groups showed no significant difference (97.7%vs.100%,P=0.219).Conclusions:In the treatment of patients suffered from cholecystolithiasis with choledocholithiasis ,both LC+LCBDE and ERCP/EST+LC are safe and effective .LC+LCBDE is associated with better cost performance ,less operation time and hospital stay .Thus,LC+LCBDE is a preferred choice for the appropriate cases of cholecystolithiasis combined with choledocholithiasis .