ERCP+LC与LCBDE+LC治疗胆囊结石合并胆总管结石疗效对比研究  

Comparison of clinical efficacy between ERCP+LC and LCBDE+LC for cholecystolithiasis complicated with choledocholithiasis

作　　者：王伟龙 温子龙[1] 郑宗敏 朱文峰 郑强[1] 薛平[1] Wang Weilong;Wen Zilong;Zheng Zongmin;Zhu Wenfeng;Zheng Qiang;Xue Ping(Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院肝胆外科,510260

出　　处：《中华肝脏外科手术学电子杂志》2021年第2期158-164,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广州市科技计划项目(201607010033)。

摘　　要：目的比较ERCP联合腹腔镜胆囊切除术(LC)与腹腔镜胆总管探查术(LCBDE)联合LC治疗胆囊结石合并胆总管结石疗效及安全性。方法回顾性分析2016年6月至2019年6月广州医科大学附属第二医院收治的147例胆囊结石合并胆总管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男77例,女70例;年龄24~65岁,中位年龄53岁。根据治疗方法不同分为ERCP+LC组和LCBDE+LC组。观察两组围手术期情况和疗效。两组住院时间、住院费用等比较采用t检验,并发症等发生率比较采用χ~2检验或Fisher确切概率法。结果 ERCP+LC组单次净石率为92%(67/73),LCBDE+LC组为92%(60/65),差异无统计学意义(χ^(2)=0.013,P>0.05)。ERCP+LC组胆总管最大直径≤8 mm者14例、>15 mm者9例,LCBDE+LC组相应为0、19例,差异有统计学意义(χ^(2)=-,6.077;P<0.05)。ERCP+LC组平均住院时间、住院费用分别为(12±3)d、(6.6±1.1)万元,均明显高于LCBDE+LC组的(9±3)d、(4.6±1.0)万元(t=4.223,11.149;P<0.05)。ERCP+LC组术后急性胰腺炎、胆漏分别为7、0例,LCBDE+LC组相应为0、6例,差异有统计学意义(P<0.05)。ERCP+LC组和LCBDE+LC组术后结石复发分别为14、11例,差异无统计学意义(χ^(2)=0.209,P>0.05)。结论 ERCP+LC和LCBDE+LC治疗胆囊结石合并胆总管结石疗效相当,两种微创术式各有优势,胆总管无扩张者首选ERCP+LC,而胆总管明显扩张、结石较大者LCBDE+LC更具优势。Objective To compare the clinical efficacy and safety between endoscopic retrograde cholangiopancreatography(ERCP)combined with laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)combined with LC in the treatment of cholecystolithiasis complicated with choledocholithiasis.Methods Clinical data of 147 patients with cholecystolithiasis complicated with choledocholithiasis admitted to the Second Affiliated Hospital of Guangzhou Medical University from June 2016 to June 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,77 patients were male and 70 female,aged from 24 to 65 years,with a median age of 53 years.All patients were divided into the ERCP+LC and LCBDE+LC groups according to different treatments.Perioperative conditions and clinical efficacy were observed between two groups.The length of hospital stay and hospitalization expense were statistically compared between two groups by t test.The incidence of complications and other parameters were compared by Chi-square test or Fisher’s exact probability test.Results The single-time stone removal rate was 92%(67/73)in ERCP+LC group and 92%(60/65)in LCBDE+LC group,where no significant difference was noted(χ^(2)=0.013,P>0.05).In ERCP+LC group,the maximum diameter of single common bile duct≤8 mm was observed in 14 casesand>15 mm in 9 cases,significantly differed from 0 and 19 cases in LCBDE+LC group(χ^(2)=-,6.077;P<0.05).In ERCP+LC group,the mean length of hospital stay and hospitalization expenses were(12±3)d and(6.6±1.1)×10^(4) yuan,which were significantly higher than(9±3)d and(4.6±1.0)×10^(4) yuan in LCBDE+LC group(t=4.223,11.149;P<0.05).In ERCP+LC group,acute pancreatitis were observed in 7 cases and no bile leakage,significantly differed from 0 and 6 cases in LCBDE+LC group(P<0.05).Stone recurrence was observed in 14 and 11 cases respectively in ERCP+LC and LCBDE+LC groups,where no significant difference was noted(χ^(

关 键 词：胆囊结石病 胆总管结石 胆囊切除术 腹腔镜 胰胆管造影术 内窥镜逆行 腹腔镜胆总管探查术 

分 类 号：R657.4[医药卫生—外科学]