回顾性研究ERCP与LCBDE治疗胆管结石临床特点及结石复发情况

目的 研究经内镜逆行胰胆管造影术(ERCP)与腹腔镜胆总管切开取石术(LCBDE)的临床治疗特点和结石复发情况,评价2种术式的优势与不足。 方法 对蚌埠医学院第一附属医院在2012年1月—2015年12月收治的胆总管结石患者的临床资料进行回顾性分析,其中184例临床资料完整,按术式分为2组:A组为ERCP组,94例;B组为LCBDE组,90例,分析2组患者的性别、年龄、胆总管最大直径、结石最大直径、结石数目、结石复发(研究患者胆总管结石首次复发情况)、住院时间、住院费用等相关指标。 结果 2组患者在年龄、结石最大直径、住院时间方面比较差异有统计学意义(均P<0.05);在性别、胆总管最大直径、结石数目、住院费用方面比较差异无统计学意义(均P>0.05);A组患者胆总管结石首次复发人数为9例,复发率为9.57%,B组患者首次复发人数为10例,复发率为11.11%,A组低于B组,但差异无统计学意义(P>0.05)。 结论 2种术式均为治疗胆总管结石的有效手术方式。高龄患者(>75岁)倾向于选择ERCP,结石直径较大的患者(≥1.5 cm)倾向于选择行LCBDE;ERCP组住院时间更短,结石复发率低于LCBDE组,但差异无统计学意义。2种术式结石复发率高峰期集中在术后1年内。 

Retrospective study of the clinical characteristics of ERCP and LCBDE in treatment of gallbladder stones and stone recurrence

Objective To study the clinical characteristics and the stone recurrence of endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic common bile duct exploration(LCBDE), and to evaluate the advantages and disadvantages of the two methods. Methods Clinical data of patients with choledocholithiasis admitted to our hospital from January 2012 to December 2015 were retrospectively analyzed. Among them, 184 cases had complete clinical data and were divided into ERCP group(94 cases) and LCBDE group(90 cases) according to surgical methods. The gender, age, maximum diameter of common bile duct, maximum diameter of calculi, number of calculi, recurrence of calculi(the first recurrence of common bile duct calculi in patients), length of stay, hospitalization costs and other related indicators were analyzed between two groups. Results There were significant differences in age, stone diameter and length of hospital stay between the two groups(all P<0.05). There were no significant differences in gender, the maximum diameter of common bile duct, number of stones and hospital expenses(all P>0.05). The first recurrence rate of choledocholithiasis was 9(9.57%) in ERCP group, and 10(11.11%) in LCBDE group, but the difference was not statistically significant(P>0.05). Conclusion The two methods are effective for the treatment of choledocholithiasis. Elderly patients(>75 years) tend to choose ERCP, while patients with large stone diameter(≥1.5 cm) tend to choose LCBDE. The hospitalization time of ERCP group is shorter, and the recurrence of ERCP group is lower, but there is no statistical difference. The peak of the recurrence rate of the two types of operation is within one year after the operation.