LCBDE与LC/ER,治疗胆囊并胆总管结石疗效比较  

Comparison of therapeutic effects for Laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancre-atography in choledocholithiasis found at time of laparoscopic cholecystectomy

作　　者：刘鹏[1] 张文兴[1] LIU Peng;ZHANG Wen-xing(Department of General Surgery,The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学附属第一医院普外科,长沙410007

出　　处：《肝胆外科杂志》2025年第1期40-44,共5页Journal of Hepatobiliary Surgery

摘　　要：目的比较内镜逆行性胰胆管造影术(Endoscopic retrograde cholangiopancreatography,ERCP)和腹腔镜胆总管探查术(Laparoscopic common bile duct exploration,LCBDE)处理胆囊切除术中发现的胆总管结石的效果。方法纳人2016年1月至2023年12月在我院行LCBDE术的105例和行LC/ERCP术的195例患者,主要比较两组患者结石清除率,其次比较两组患者住院时间、30天内再人院、重返手术室再次手术发生率、患者手术次数、术后并发症及死亡率。结果LC/ERCP对胆总管(Common bile duct,CBD)的清除率优于LCBDE(97.9%vs89.5%,P=0.001),但患者行手术次数更多(1.1±0.4vs2.0±0.2,P=0.001)。两种方法并发症发生率、住院时间、再人院时间无统计学差异(P>0.05)。ERCP失败4例,LCBDE失败12例,随后又有10例ERCP和2例CBD探查术失败。所有胃旁路术(Roux-en-Y gastric bypass,RYGB)患者腹腔镜胆总管探查术(LCBDE)均取得成功。结论仑LC/ERCP对胆总管结石的清除效果优于LCBDE,是治疗RYGB患者的有效方法,但LC/ERCP和LCBDE的术后并发症率无差异.Objective To compare the efficacy of endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic common bile duct exploration(LCBDE)in the therapy of common bile duct stones.Methods We recruited 105 patients who under-went LCBDE and 195 patients who underwent LC/ERCP,in our hospital from January 2016 to December 2023.Results LC/ERCP had a better removal of common bile duct(CBD)(97.9%vs 89.5%,p=0.01),but each patient required more surgery(mean±SD,1.1,±0.4 Vs 2.0±0.12,P<0.001).There was no significant diference in incidence,length of hospital stay,and time of re-admission between the two methods(P>0.05).ERCP failed in 4 cases,LCBDE failed in 12 cases,followed by 10 cases of ERCP or 2 cases of CBD exploration failure.Laparoscopic common bile duct exploration(LCBDE)was successful in all RYGB patients.Con-clusion LC/ERCP is superior to LCBDE in the removal of common bile duct stones.It is an effective method for the treatment of RYGB patients,but the incidence of postoperative disease is similar between LC/ERCP and LCBDE.

关 键 词：腹腔镜 胆囊切除术 腹腔镜普通胆管探查术 ERCP 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]