基于倾向性评分匹配法评价三种方法治疗胆囊切除术后胆总管结石的疗效  

Evaluation of curative effect of three methods for treating common bile duct stones after cholecystectomy based on propensity score matching method

作　　者：卢建利 贺伟 刘进衡 LU Jianli;HE Wei;LIU Jinheng(Department of Hepatopancreatobiliary Surgery,363 Hospital,Chengdu,610000,China;不详)

机构地区：[1]三六三医院肝胆胰外科,610000成都 [2]成都市第二人民医院肝胆胰外科

出　　处：《临床外科杂志》2023年第7期635-639,共5页Journal of Clinical Surgery

摘　　要：目的对比实施开腹胆总管探查术(OCBDE)、经内镜逆行性胰胆管造影及乳头括约肌切开术(ERCP/EST)、腹腔镜下胆总管探查术(LCBDE)3种不同手术方式治疗在胆囊切除术后胆总管结石治疗的疗效。方法2016年7月~2020年7月我院肝胆胰外科收治的胆囊切除术后胆总管结石病人109例。按手术方法分为ERCP组(33例),OCBDE组(40例),LCBDE组(36例),采用倾向性评分匹配法(PSM)均衡各组间的混杂因素影响,比较匹配后三组的临床疗效和并发症。结果经PSM法各组均纳入28例病人,三组病人基线资料比较均无统计学意义(P>0.05)。三组手术成功率及第一次结石清除率比较,差异均无统计学意义(P>0.05),其中ERCP组手术出血量、手术时间、术后肛门排气时间及术后住院时间均低于/短于OCBSE组与LCBDE组,差异有统计学意义(P<0.05),而LCBDE组手术出血量、手术时间、术后肛门排气时间及术后住院时间均低于/短于OCBSE组,差异有统计学意义(P<0.05)。ERCP组围术期并发症发生率与其余两组比较,差异均无统计学意义(P>0.05),而LCBDE组术后并发症发生率低于OCBDE组,差异有统计学意义(P<0.05)。术后随访发现,ERCP组结石残留率高于OCBDE组与LCBDE组,差异有统计学意义(P<0.05),而OCBDE组与LCBDE组结石残留率比较,差异无统计学意义(P>0.05)。结论ERCP、OCBDE以及LCBDE均可有效清除胆囊切除术后胆总管结石,其中ERCP手术创伤小,但术后易发生急性胰腺炎、高淀粉酶血症等严重并发症,且术后结石残留率高,LCBDE术微创优势强于OCBDE,但其不适用于腹腔严重粘连者,建议根据病人具体情况,选择合适的手术方法。Objective To compare the efficacy of three different surgical methods in the treatment of common bile duct stones after cholecystectomy:open common bile duct exploration(OCBDE),endoscopic retrograde cholangiopancreatography and papillary sphincterotomy(ERCP/EST),and laparoscopic common bile duct exploration(LCBDE).Methods The clinical data of 109 cases of recurrent choledocholithiasis after cholecystectomy treated in our hospital from July 2016 to July 2020 were analyzed retrospectively.Among them,33 cases were ERCP,40 cases were OCBDE group,and 36 cases were LCBDE.The influence of confounding factors among the groups was balanced by the tendentious score matching method(PSM),and the clinical efficacy and complications of the three groups after matching were compared.Results 28 patients were included in each group by PSM method,and the baseline data of the three groups were not statistically significant(P>0.05).No statistical difference was found in the success rate of operation and stone clearance rate among three groups(P>0.05).The specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in ERCP group were lower/shorter than those in OCBSE group and LCBDE group,with obvious difference(P<0.05),while the specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in LCBDE group were lower/shorter than those in OCBSE group,with obvious difference(P<0.05).The incidence rate of perioperative complications of ERCP group showed no obvious difference with that of other 2 groups(P>0.05),while the incidence rate of postoperative complications in LCBDE group was lower than that in OCBDE group,with statistical difference(P<0.05).Postoperative follow-up showed that the recurrence rate of common bile duct stones in ERCP group was higher than OCBDE and LCBDE groups,with statistical difference(P<0.05),while the recurrence rate yielded no statistic

关 键 词：胆总管结石 胆囊切除术 胆总管切开取石术 内镜下逆行胰胆管造影取石术 腹腔镜下胆总管探查术 疗效对比 倾向性评分匹配 

分 类 号：R657.4[医药卫生—外科学]