腹腔镜胆囊切除术联合腹腔镜胆总管探查一期缝合术与内镜乳头括约肌切开取石术治疗胆囊结石合并胆总管结石  

A comparison of laparoscopic cholecystectomy with primary anastomosis of choledochotomy and endoscopic treatment for bile duct stones in patients with cholelithiasis

作　　者：鲁瑞宏 武博文 吴友志 LU Ruihong;WU Bowen;WU Youzhi(Shihezi University School of Medicine,Shihezi,Xinjiang 832002,China)

机构地区：[1]石河子大学医学院,新疆石河子832002

出　　处：《中国医学工程》2022年第2期11-15,共5页China Medical Engineering

摘　　要：目的探究腹腔镜胆囊切除术(LC)联合不同取石方式的临床疗效及对结石复发的影响。方法回顾性分析石河子大学医学院附属医院在2016年6月至2017年8月诊断为胆囊结石合并胆总管结石的患者资料,根据手术方式分为LC联合腹腔镜胆总管探查一期缝合术(LC+LBEPS)组(n=75),内镜乳头括约肌切开取石术联合LC(LC+EST)组(n=114)。比较两组的人口学指标,实验室检查结果,围手术期情况,住院总花费,远期复发情况。结果在两组人口学指标、实验室检查结果差异无统计学意义的情况下,LC+LBEPS组结石取净率更高(93.4%vs.83.4%,P<0.05),手术时间更短,术后并发症更少,住院时间更短,住院费用更低(P<0.05);而LC+EST组的术中出血量更少(P<0.05)。此外,LC+LBEPS组结石复发率更低(4%vs.13%,P<0.05),且为结石复发的独立危险因素(OR=0.25,95%CI:0.1~0.9,P=0.034)。结论患者接受LC+LBEPS治疗的优势更加明显,但对于胆总管末端结石或结石较小但无法通过保守治疗排出的患者,通过LC+EST治疗可能获益更多。【Objective】To explore the relative safety and efficacy of laparoscopic choledochotomy combined with different treatment for bile duct stones in patients with cholelithiasis.【Methods】The patients who were diagnosed cholecystolithiasis and choledocholithiasis by the Affiliated Hospital of Medical College from June 2016 to August 2017 were divided into two groups according to the mode of operation:laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration and primary suture(LC+LBEPS)(n=75)and endoscopic sphincterotomy combined with laparoscopic cholecystectomy(LC+EST)(n=114).The demographic index,laboratory examination,perioperative condition,total hospitalization cost and long-term recurrence were compared between the two groups.【Results】When there was no statistical difference in demographic indexes and laboratory examination results between the two groups,the stone removal rate was higher in the LC+LBEPS group(93.4%vs.83.4%,P<0.05),the operation time and the hospital stay was shorter,the postoperative complications were less,and the hospitalization cost was lower(P<0.0 l),while the intraoperative bleeding in the LC+EST group was less(P<0.05).In addition,the recurrence rate of stones in the LC+LBEPS group was lower(4%vs.13%,P<0.05)and the mode of operation was an independent risk factor for stone recurrence(O^R=0.25,95%CI:0.1-0.9,P=0.034).【Conclusion】The advantage of LC+LBEPS treatment for patients is more obvious,but for patients with small stones at the end of common bile duct or stones that cannot be excreted through conservative treatment,LC+EST treatment may benefit more.

关 键 词：胆总管结石 腹腔镜胆囊切除术 消化内镜 一期缝合 

分 类 号：R657.4[医药卫生—外科学]