两种胆总管结石合并胆囊结石治疗方案的比较研究  

A comparative study of two treatment methods for choledocholithiasis combined with cholecystolithiasis

作　　者：张平 袁玉斌 季淑婷 孔杰 叶永强[1] 王琛[1] 李辉[1] 赵海旺[1] 孙智勇[1] 石合现 Zhang Ping;Yuan Yubin;Ji Shuting;Kong Jie;Ye Yongqiang;Wang Chen;Li Hui;Zhao Haiwang;Sun Zhiyong;Shi Hexian(Department of Hepatobiliary Surgery,Heze Municipal Hospital,Heze 27400,China)

机构地区：[1]菏泽市立医院肝胆外科,菏泽274000

出　　处：《中华肝胆外科杂志》2024年第12期917-921,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的比较内镜逆行胰胆管造影/内镜乳头括约肌切开+腹腔镜胆囊切除术(ERCP/EST+LC)与LC+胆总管探查取石术(LCBDE)治疗胆总管结石合并胆囊结石的临床疗效。方法回顾性研究分析2018年3月至2021年3月菏泽市立医院收治的172例胆总管结石合并胆囊结石患者临床资料,其中男性78例,女性94例,年龄(66.88±9.72)岁。根据手术方式分为两组:行LC+LCBDE的患者86例纳入LC+LCBDE组,行ERCP/EST+LC的患者86例纳入ERCP/EST+LC组。比较两组患者的结石清除率、手术时间、术中出血量、术后并发症等指标。结果胆总管结石最大径≥1.2 cm时,ERCP/EST+LC组首次结石清除率为76.5%(13/17),小于LC+LCBDE组的96.3%(26/27),差异有统计学意义(χ^(2)=4.07,P=0.044)。胆总管结石数目≥3个时,ERCP/EST+LC组首次结石清除率78.9%(15/19)小于LC+LCBDE组的96.7%(29/30),差异有统计学意义(χ^(2)=3.99,P=0.046)。LC+LCBDE组和ERCP/EST+LC组的手术时间分别为(129.07±19.33)min和(101.86±27.48)min,二者差异具有统计学意义(t=7.51,P<0.001)。LC+LCBDE组和ERCP/EST+LC组的术中出血量分别为25.0(20.0,30.0)ml和13.0(10.0,15.0)ml,二者差异具有统计学意义(Z=916.00,P<0.001)。两组患者在年龄、性别、术前结石最大径、结石数目、术前胆总管内径、手术成功率、术后住院时间、总结石清除率、并发症发生率方面差异均无统计学意义(均P>0.05)。结论LC+LCBDE和ERCP/EST+LC均可以安全有效地治疗胆总管结石伴胆囊结石,当患者胆总管结石最大径≥1.2 cm或胆总管结石数目≥3个时,应优先考虑LC+LCBDE,而当患者一般情况欠佳时,应优先考虑ERCP/EST+LC。ObjectiveTo compare the treatment effect of endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy plus laparoscopic cholecystectomy(ERCP/EST+LC)and laparoscopic cholecystectomy plus laparoscopic common bile duct exploration(LC+LCBDE)for patients with choledocholithiasis combined with gallbladder stones.MethodsClinical data of 172 patients with choledocholithiasis combined with gallbladder stones treated in Heze Municipal Hospital from March 2018 to March 2021 were retrospectilvely analyzed,including 78 males and 94 females,aged(66.88±9.72)years.According to surgical method,patients were divided into the ERCP/EST+LC group(n=86)and LC+LCBDE group(n=86).The initial clearance rate of choledochal stones,operation time,intraoperative blood loss and postoperative complications were compared between the groups.ResultsThe initial clearance rate of the choledochal stones of the ERCP/EST+LC group is 76.5%(13/17),lower than 96.3%(26/27)of LC+LCBDE group when the diameter of stones was over 1.2 cm(χ^(2)=4.07,P=0.044).When the number of choledochal stones were more than 3,the initial clearance rate of the ERCP/EST+LC group is 78.9%(15/19),lower than that of the LC+LCBDE group[96.7%(29/30),χ^(2)=3.99,P=0.046].The operation time of LC+LCBDE group was longer than that of ERCP/EST+LC group[(129.07±19.33)min vs.(101.86±27.48)min,t=7.51,P<0.001].The median intraoperative blood loss of LC+LCBDE group and ERCP/EST+LC group was 25.0(20.0,30.0)ml and 13.0(10.0,15.0)ml,respectively(Z=916.00,P<0.001).The age,gender,maximum diameter of stones,number of stones,preoperative common bile duct diameter,surgical success rate,postoperative hospital stay,total stone clearance rate,and complication rate were comparable between the groups(all P>0.05).ConclusionBoth LC+LCBDE and ERCP/EST+LC are safe and feasible for choledocholithiasis combined with cholecystolithiasis.When the maximum diameter of choledochal stones is≥1.2 cm or the number of choledochal stones is≥3,LC+LCBDE should be favored.When patient is in poor genera

关 键 词：胆总管结石病 胆囊结石 逆行胰胆管造影 胆总管探查 

分 类 号：R65[医药卫生—外科学]