LC+LERV与LC+LCBDE治疗胆囊结石合并胆总管结石的临床效果比较  

Clinical efficacy between LC+LERV and LC+LCBDE in the treatment of gallbladder stones combined with common bile duct stones

作　　者：陈庆[1] 王春斐 何彦安[1] 严超 何永红[1] CHEN Qing;WANG Chunfei;HE Yan’an;YAN Chao;HE Yonghong(Department of Hepatobiliary Surgery,Jiangyou People’s Hospital,Jiangyou,Sichuan 621700,China;Department of Gastroenterology,Weifang People’s Hospital,Weifang,Shandong 261000,China)

机构地区：[1]江油市人民医院肝胆外科,四川江油621700 [2]潍坊市人民医院消化内科,山东潍坊261000

出　　处：《肝胆胰外科杂志》2024年第3期155-160,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：江油市重点科技计划项目(2021-32)。

摘　　要：目的通过对比分析腹腔镜胆囊切除术(LC)+腹腔镜术中联合内镜(LERV)与LC+腹腔镜胆总管切开取石(LCBDE)对胆囊结石合并胆总管结石的临床疗效,探讨两种手术方式的临床应用价值。方法前瞻性分析2021年12月至2023年5月江油市人民医院和潍坊市人民医院收治的110例胆囊结石合并胆总管结石患者的临床资料,按随机数字表法分为LC+LERV组(n=54)和LC+LCBDE组(n=56),对两组患者的手术成功率、术中出血量、手术时间、引流管留置时间、术后并发症、疼痛视觉模拟评分(VAS)、平均住院时间以及住院费用进行比较分析。结果与LC+LCBDE组相比,LC+LERV组手术成功率较低[47(87.04%)vs 56(100.00%),χ2=7.467,P=0.006],手术时间较长[(112.0±15.6)min vs(98.0±21.5)min,t=3.771,P<0.001],但引流管留置时间明显较短[(2.34±0.66)d vs(7.41±12.88)d,t=-2.693,P=0.008],两组比较差异均具有统计学意义(P<0.05)。两组在术中出血量、术后并发症发生率方面比较,差异无统计学意义(P>0.05);两组在术前、术后6 h、术后1 d及出院日VAS评分差异无统计学意义(P>0.05),但术后3 d LC+LCBDE组VAS评分高于LC+LERV组(P<0.05)。两组平均住院时间差异无统计学意义(P>0.05),但LC+LERV组平均住院费用明显高于LC+LCBDE组[(25653.6±3317.0)元vs(17978.4±2158.0)元,t=14.219,P<0.001]。结论在治疗胆囊结石合并胆总管结石方面,LC+LCBDE和LC+LERV安全性上表现一致,LC+LERV术后舒适性更佳,但LC+LCBDE在治疗有效性、经济效率性方面更好,且LC+LCBDE可作为LC+LERV插管或取石失败后的补救术式。根据具体病情个性化选择手术方式,有利优势互补,获得最佳治疗效果。Objective To compare the clinical efficacy of laparoscopic cholecystectomy(LC)combined with laparo-endoscopic rendezvous(LERV)and LC+laparoscopic common bile duct exploration(LCBDE)in the treatment of gallbladder stones combined with common bile duct stones.Methods A prospective study was conducted in 110 patients with gallbladder stones and common bile duct stones who admitted to Jiangyou People’s Hospital and Weifang People’s Hospital between Dec.2021 and May 2023.With a random number table method,patients were randomly divided into LC+LERV group(n=54)and LC+LCBDE group(n=56).The surgical success rate,intraoperative bleeding volume,operation time,time of indwelling drainage tube,postoperative complications,hospitalization time and hospitalization costs,pain visual analogue scale(VAS)of the two groups were compared.Results Compared with the LC+LCBDE group,the LC+LERV group had lower surgical success rate(87.04%vs 100.00%,χ2=7.467,P=0.006),longer operation time[(112.0±15.6)min vs(98.0±21.5)min,t=3.771,P<0.001],and shorter time of indwelling drainage tube[(2.34±0.66)d vs(7.41±12.88)d,t=-2.693,P=0.008],the differences were all statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of intraoperative bleeding volume and incidence of postoperative complications(P>0.05).There was no statistically significant difference in VAS scores between the two groups before surgery,6 h and 1 d after surgery,on the day of discharge(P>0.05),but the VAS score 3 d after surgery in the LC+LCBDE group was significantly higher than that in the LC+LERV group(P<0.05).There was no statistically significant difference in hospitalization time between the two groups(P>0.05),but the hospitalization cost in the LC+LERV group was significantly higher than that in the LC+LCBDE group[(25653.6±3317.0)yuan vs(17978.4±2158.0)yuan,t=14.219,P<0.001].Conclusion For treatment of gallbladder stones combined with common bile duct stones,LC+LCBDE and LC+LERV have the same safety performa

关 键 词：腹腔镜胆囊切除术(LC) 腹腔镜术中联合内镜(LERV) 腹腔镜胆总管切开取石术(LCBDE) 胆囊结石 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]