胆囊结石合并胆总管结石不同治疗方案的临床分析  

Clinical analysis of different treatment options for cholecysto-choledocholithiasis

作　　者：陈平[1] 苏秉忠[1] 丛春莉[1] 王宏霞[1] 张彤[2] 任建军[2] 王琦[2] 刘旭东[2] Chen Ping;Su Bingzhong;Cong Chunli;Wang Hongxia;Zhang Tong;Ren Jianjun;Wang Qi;Liu Xudong(Department of Gastroenterology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China;Department of Gastroenterology and Emergency Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China)

机构地区：[1]内蒙古医科大学附属医院消化内科,呼和浩特010050 [2]内蒙古医科大学附属医院急诊外科,呼和浩特010050

出　　处：《中华消化杂志》2019年第1期40-44,共5页Chinese Journal of Digestion

基　　金：2017年内蒙古科技计划项目(kjjh17).

摘　　要：目的通过评估胆囊结石合并胆总管结石(CCL)患者采用不同治疗方案的疗效,寻求理想的治疗方法。方法纳入2006年1月至2016年1月于内蒙古医科大学附属医院就诊的3 107例CCL患者,其中开腹胆囊切除术(OC)+胆总管切开取石术(OCBDE)组1 283例,腹腔镜下胆囊切除术(LC)+腹腔镜下胆总管切开取石术(LCBDE)组964例,ERCP+LC组860例。分析3组的临床资料,统计学方法采用单因素方差分析和卡方检验。结果 2006年至2010年,采用OC+OCBDE、LC+LCBDE和ERCP+LC治疗的患者分别占56.05%(829/1 479)、25.15%(372/1 479)和18.80%(278/1 479);2011年至2016年,采用上述3种方法治疗的患者分别占27.89%(454/1 628)、36.36%(592/1 628)和35.75%(582/1 628);同一种治疗方法在不同时期所占比例差异均有统计学意义(χ^2=4.775、4.168、0.669,P均<0.05)。OC+OCBDE组患者手术成功率为100.00%(1 370/1 370);LC+LCBDE组患者手术成功率为94.26%(920/976),56例转行OC+OCBDE;ERCP+LC组患者手术成功率为95.00%(817/860),31例转行OC+OCBDE,12例转行LC+LCBDE。OC+OCBDE组、LC+LCBDE组和ERCP+LC组术中并发症发生率分别为2.85%(39/1 370)、3.48%(32/920)和1.22%(10/817),术后并发症发生率分别为4.89%(67/1 370)、5.43%(50/920)和5.51%(45/817);ERCP+LC组的术中并发症发生率低于OC+OCBDE组和LC+LCBDE组,差异均有统计学意义(χ^2=6.203、3.001,P均<0.05);3组术后并发症发生率差异无统计学意义(P>0.05)。OC+OCBDE组、LC+LCBDE组和ERCP+LC组的住院时间分别为(6.7±1.3)、(5.6±1.2)和(10.9±1.6) d,差异有统计学意义(F=90.010,P<0.01)。OC+OCBDE组、LC+LCBDE组和ERCP+LC组的住院费用分别为(1.372±0.191)、(1.815 ±0.149)和(2.583±0.243)万元,差异有统计学意义(F=302.991,P<0.01)。结论 CCL患者首选内镜微创治疗,开腹手术可作为内镜微创手术的补救措施。Objective To evaluate the efficacy of different treatment options for cholecysto-choledocholithiasis (CCL), and try to find the ideal treatment. Methods From January 2006 to January 2016, a total of 3 107 patients with CCL from the Affiliated Hospital of Inner Mongolia Medical University were enrolled. Among them, 1 283 patients were in open cholecystectomy (OC) and open common bile duct exploration (OCBDE) group, 964 patients were in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) group, and 860 patients were in endoscopic retrograde cholangiopancreatography (ERCP)+ LC group. The clinical data of the three groups were analysed. One-way analysis of variance and chi-square test were performed for statistical analysis. Results From 2006 to 2010, the percentage of patients treated with OC+ OCBDE, LC+ LCBDE, and ERCP+ LC were 56.05%(829/1 479), 25.15%(372/1 479) and 18.80%(278/1 479), respectively;from 2011 to 2016, the percentage of patients received the above three treatments were 27.89%(454/1 628), 36.36%(592/1 628) and 35.75%(582/1 628), respectively. The difference in the proportion of the same treatment at different times was statistically significant (χ^2=4.775, 4.168 and 0.669, all P<0.05). The success rate of surgery in the OC+ OCBDE group was 100.00%(1 370/1 370);while the success rate of surgery in the LC+ LCBDE group was 94.26%(920/976), and 56 patients converted to OC+ OCBDE;the success rate of surgery in the ERCP+ LC group was 95.00%(817/860), and 31 patients converted to OC+ OCBDE, and 12 patients to LC+ LCBDE. The intraoperative complication in OC+ OCBDE, LC+ LCBDE and ERCP+ LC were 2.85%(39/1 370), 3.48%(32/920) and 1.22%(10/817), respectively. The incidence rates of postoperative complication were 4.89%(67/1 370), 5.34%(50/920) and 5.51%(45/817), respectively. The incidence rates of intraoperative complication of the ERCP+ LC group was lower than that of OC+ OCBDE group and LC+ LCBDE group, and the differences were statistically significant (χ^2=6.203 and 3.

关 键 词：胆囊结石合并胆总管结石 内镜微创手术 外科开腹手术 

分 类 号：R657.42[医药卫生—外科学]