腹腔镜联合胆道镜一期手术与十二指肠镜联合腹腔镜分期手术治疗细径胆总管结石合并胆囊结石的疗效比较  

Comparison of the efficacy of LC+LCBDE one-stage surgical procedure and ERCP+LC two-stage surgical procedure in the treatment of small diameter choledocholithiasis combined with gallbladder stones

作　　者：蔡雪军 李永元 沈建伟 张立明 邵志江 Cai Xuejun;Li Yongyuan;Shen Jianwei;Zhang Liming;Shao Zhijiang(Department of Hepatobiliary Surgery,Tianjin No.5 Central Hospital(Peking University Binhai Hospital),Tianjin 300450,China)

机构地区：[1]天津市第五中心医院(北京大学滨海医院)肝胆外科,天津300450

出　　处：《中华解剖与临床杂志》2022年第5期343-348,共6页Chinese Journal of Anatomy and Clinics

基　　金：天津市滨海新区卫生计生委科技项目(2018BWKY018)。

摘　　要：目的比较腹腔镜和胆道镜双镜联合一期手术与经典的十二指肠镜和腹腔镜分期手术治疗细径胆总管结石合并胆囊结石的临床疗效。方法回顾性队列研究。纳入2016年4月—2020年8月天津市第五中心医院肝胆外科收治的细径胆总管(直径≤0.8 cm)结石合并胆囊结石患者121例,其中男80例、女41例,年龄18~84岁。根据治疗方法的不同分为2组:ERCP+LC组59例,采用十二指肠镜胆总管取石+腹腔镜胆囊切除术分期方案治疗;LC+LCBDE组62例,采用腹腔镜胆囊切除+术中胆道镜经胆囊管途径取石术一期治疗。比较2组患者住院时间、肝功能指标、手术并发症等情况。结果ERCP+LC组和LC+LCBDE组患者的性别构成、年龄及胆总管直径和结石数量比较,差异均无统计学意义(P值均>0.05)。LC+LCBDE组住院时间(9.32±5.20)d,少于ERCP+LC组的(13.35±8.67)d,差异有统计学意义(t=3.12,P=0.002)。出院前1天:LC+LCBDE组丙氨酸转氨酶为(36.5±15.2)U/L、天冬氨酸转氨酶为(36.3±11.2)U/L,明显低于ERCP+LC组的丙氨酸转氨酶(73.1±53.7)U/L、天冬氨酸转氨酶(55.5±40.3)U/L,差异均有统计学意义(t=5.16、3.61,P值均<0.001);而2组患者的总胆红素和直接胆红素比较差异均无统计学意义(t=0.85、1.29,P值均>0.05)。ERCP+LC组有2例(3.3%)术后血淀粉酶水平升高,LC+LCBDE组有1例(1.6%)术后出现胆漏,2组并发症发生率比较差异无统计学意义(χ2=0.63,P=0.529)。结论与ERCP+LC组相比,LC+LCBDE方案治疗的细径胆总管结石患者住院时间更短,肝功能恢复更快,避免了对乳头括约肌的切开,LC+LCBDE方案安全有效,临床效果更好。Objective This study aimed to investigate the surgical protocol of combined laparoscopic and cholangioscopic double-scope one-stage procedure of small diameter choledocholithiasis combined with gallbladder stones and the classical duodenoscopic and laparoscopic two-stage procedure and to compare the clinical efficacy of the two different surgical treatments.Methods A retrospective analysis was conducted on 121 patients(80 males and 41 females;18-84 years old)with small diameter common bile duct(diameter≤0.8 cm)stones combined with gallbladder stones who were admitted to Tianjin No.5 Central Hospital from April 2016 to August 2020.The patients were divided into two groups according to the different treatment methods.The first group(59 patients)was treated with the combined method of duodenoscopic extraction of common bile duct stones and laparoscopic cholecystectomy(i.e.,ERCP+LC),whereas the second group(62 patients)was treated with laparoscopic cholecystectomy+intraoperative choledochoscopy via cystic duct route lithotripsy(i.e.,LC+LCBDE).The length of hospital stay,liver function indexes,and complications were compared between the two groups.Results No statistically significant differences were found in the gender composition ratio,age,and the diameter of the common bile duct and the number of stones between the two groups(all P values>0.05).The mean length of stay in the LC+LCBDE group([9.32±5.20]days)was lower than that in the ERCP+LC group([13.35±8.67]days),and the difference was statistically significant(t=3.12,P=0.002).The ALT([36.5±15.2]U/L)at 1 day before discharge was lower in the LC+LCBDE group than in the ERCP+LC group([73.1±53.7]U/L),and the AST([36.3±11.2]U/L)at 1 day before discharge was lower in the LC+LCBDE group than in the ERCP+LC group([55.5±40.3]U/L);the difference was statistically significant(t=5.16,t=3.61,all P values<0.001).No significant difference was found between the TBIL and DBIL(t=0.85,t=1.29,all P values>0.05)of the two groups at 1 day before discharge.Two patients(3.3%)in t

关 键 词：胆总管结石 胆囊切除术 腹腔镜 经胆囊管取石 胆道镜 十二指肠镜 

分 类 号：R657.4[医药卫生—外科学]