内镜与腹腔镜联合一期与二期治疗胆囊结石合并胆总管结石疗效的前瞻性研究  

Comparison of efficacy and safety of combined endoscopic-laparoscopic methods for single-stage versus two-stage for patients with concomitant gallbladder stones and common bile duct stones

作　　者：刘军[1] 刘云宏[2] 何均辉[1] 马文贵[2] 鲍俊初[3] 晏洁影[1] 

机构地区：[1]深圳市宝安区松岗人民医院消化内科,广东深圳518105 [2]深圳市宝安区松岗人民医院普通外科,广东深圳518105 [3]深圳市宝安区松岗人民医院放射科,广东深圳518105

出　　处：《岭南现代临床外科》2016年第5期530-534,共5页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨一期与二期腹腔镜联合内镜的不同治疗方法对胆囊结石同时合并胆总管结石患者的治疗疗效及安全性。方法 104例符合标准的患者分为2组:一期腹腔镜胆总管探查联合腹腔镜胆囊切除术(LCBDE+LC组,n=55)和二期内镜逆行性胰胆管造影术联合Oddi括约肌切开序贯腹腔镜胆囊切除术(ERCP/S+LC组,n=49)。分析探讨两组患者手术成功率、术后并发症和术后住院时间的差异。结果两组患者在流行病学和临床病例特点方面无明显差异,提示两组患者具有可比性。LCBDE+LC组和ERCP/S+LC组的患者手术成功率相近(分别为90.0%和95.9%,P=0.309),但ERCP/S+LC组的患者结石清除率更高(分别为93.6%和80.0%,P=0.046),两组患者术后并发症发生率无明显差异。此外,两组患者在术后住院时间和总体住院费用方面亦相近。在术后随访期间,LCBDE+LC组和ERCP/S+LC组分别有5.9%(3/51)和6.3%(3/48)的患者发现胆总管结石残留,差异无显著的统计学意义。结论胆囊结石同时合并胆总管结石的一期和二期双镜联合治疗方法具有相近的成功率,术后并发症发生率相若,远期复发无明显差异,但二期双镜联合治疗的手术结石清除率更高。Objective To evaluate the efficacy, safety of combined endoscopic-laparoscopic method for single-stage and two-stage treatment method for patients with gallbladder and CBD stones. Methods One hundred and four eligible patients were divided into 2 groups, single-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy （LCBDE ＋LC,n =55）or two-stage endoscopic retrograde cholangiopancreatography sphincterotomy plus laparoscopic cholecystectomy （ERCP/S＋LC group,n=49）. The surgical successful rate, postoperative complications and postoperative length of hospital stay were assessed. Results The two group were matched with regard to demographic and clinical parameters. Both LCBDE＋LC and ERCP/S＋LC had similar success rates （90.0% vs 95.9%, P=0.309）. However, the cases in the ERCP/S＋LC group had higher rate of stone clearance （93.6% vs 80.0%, P=0.046）. The two groups did not differ significantly in terms of postoperative complications. In addition, no significant difference was observed in terms of postoperative hospital stay and overall cost. We observed the 6.0% （3/50） and 6.3% （3/48） cases in LCBDE＋LC and ERCP/ S＋LC group with recurrent stone in the CBD during the postoperative follow-up period, which had no statistical significance. Conclusion Single-and two-stage management for concomitant gallbladder and CBD stones had similar success rate, postoperative complication incidence and long-term recurrence ration, but ERCP/S ＋LC group had higher stone clearance rate. Hence ERCP/S ＋LC should be an optimal therapeutic approach for concomitant gallbladder and CBD stones.

关 键 词：胆囊结石同时合并胆总管结石 腹腔镜 ERCP 胆道镜 

分 类 号：R657.3[医药卫生—外科学]