腹腔镜一步法与内镜联合腹腔镜两步法治疗80岁以上胆囊结石合并胆总管结石的疗效比较  

Comparing one-step common bile duct exploration plus cholecystectomy with two-step endoscopic sphincterotomy plus cholecystectomy in patients over 80 years with concomitant gallbladder and common bile duct stones

作　　者：段建文[1] 袁磊 孙运鹏[2] 孙达 徐大鹏 肖铭甲 沈红波 卢家俊 Duan Jianwen;Yuan Lei;Sun Yunpeng;Sun Da;Xu Dapeng;Xiao Mingjia;Shen Hongbo;Lu Jiajun(Department of Hepatobiliary Surgery,Quzhou Hospital Affiliated of Wenzhou Medical University(Quzhou People's Hospital),Quzhou 324000,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)肝胆外科,衢州324000 [2]温州医科大学附属第一医院肝胆外科,温州325035

出　　处：《中华肝胆外科杂志》2023年第3期185-189,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：衢州市科技局指导性课题(2019106)。

摘　　要：目的:比较常见的腹腔镜一步法(即胆总管探查+胆囊切除,LCBDE+LC)与内镜联合腹腔镜胆囊切除两步法(ERCP+LC)手术治疗老年胆囊合并胆总管结石的安全性和有效性。方法:回顾性分析2014年1月至2020年12月分别就诊于温州医科大学附属衢州医院和温州医科大学附属第一医院肝胆外科的胆囊结石合并胆总管结石年龄大于80岁的492例患者的临床资料,其中男性254例,女性238例,年龄(83.9±3.0)岁。按不同手术方式分为腹腔镜一步法组(LCBDE+LC,n=186)和内镜腔镜两步法组(ERCP+LC,n=306),比较两组患者的手术、结石和住院费用等指标的差异。结果:与两步法组相比,一步法组患者既往行胃大部切除术比例更高[21.5%(40/186)比4.2%(13/306)],多发结石更多见[77.4%(144/186)比49.3%(151/306)],结石最大径更大[13.7(6.4,18.6)mm比10.9(5.7,16.1)mm],住院费用更低[(2.37±0.31)万元比(3.26±0.44)万元],差异均有统计学意义(均P<0.05)。一步法组与两步法组的结石残余率[2.7%(5/186)比1.3%(4/306)]、结石复发率[2.2%(4/186)比5.2%(16/306)]、术后总并发症发生率[3.2%(6/186)比1.3%(4/306)]和总住院时间[(10.7±6.2)d比(11.3±5.4)d]差异均无统计学意义(均P>0.05)。结论:一步法(LCBDE+LC)对于治疗胆囊结石合并胆总管结石的老年患者是安全且经济有效的,尤其对于既往行胃大部切除术、结石多发且体积较大、不能配合行内镜治疗的老年患者,可作为首选的治疗方法。Objective To compare safety and efficacy of one-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy(LCBDE+LC)with endoscopic retrodrade cholangiopancreatography plus laparoscopic cholecystectomy(ERCP+LC)in elderly patients with concomitant gallbladder and common bile duct(CBD)stones.Methods This is a two-center retrospective study with clinical data on 492 patients aged over 80 years diagnosed with concomitant gallbladder and CBD stones treated between January,2014 and December,2020 at The First Affiliated Hospital of Wenzhou Medical University and Quzhou Hospital Affiliated to Wenzhou Medical University.There were 254 males and 238 females,aged(83.9±3.0)years.These patients were divided into two groups based on their operative methods:the one-stage group(LCBDE+LC,n=186)and the two-stage group(ERCP+LC,n=306).Differences in surgery,stones and hospitalization costs were compared between the two groups.Results When compared with the ERCP+LC group,the LCBDE+LC group had significantly higher incidences of previous gastrectomy[21.5%(40/186)vs 4.2%(13/306)],multiple stones[77.4%(144/186)vs 49.3%(151/306)],larger stone diameter[13.7(6.4,18.6)mm vs 10.9(5.7,16.1)mm],and increased hospitalization expenditure[(2.37±0.31)Wanyuan vs(3.26±0.44)Wanyuan](all P<0.05).However,the rates of residual stone[2.7%(5/186)vs 1.3%(4/306)],stone recurrence[2.2%(4/186)vs 5.2%(16/306)],postoperatively overall complications[3.2%(6/186)vs 1.3%(4/306)],and total hospital stay[(10.7±6.2)d vs(11.3±5.4)d]were not significantly different between the two groups(all P>0.05).Conclusions Allowing for the similar safety and effectiveness,and lower hospitalization expenditure,LCBDE+LC was a preferred choice for patients aged over 80 year,especially in patients who had previous gastrectomy,multiple large CBD stones,or who could not accept endoscopic procedures for treatment of CBD stones.

关 键 词：胆总管结石病 胆囊结石 腹腔镜胆囊切除术 内镜括约肌切开术 

分 类 号：R657.42[医药卫生—外科学]