LC＋LCBDE与ERCP/S＋LC治疗胆囊结石合并胆总管结石的临床研究

doi:10.3877/cma.j.issn.1674-6899.2017.04.009

目的

研究两种微创手术[腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC) ＋腹腔镜胆总管探查切开取石术(laparoscopic common bile duct exploration and stone extraction，LCBDE)和内镜下逆行性胆胰管造影术(endoscopic retrograde cholangiopancreatography，ERCP)/内镜下括约肌切开取石术(endoscopic sphincterotomy，EST) ＋LC]在治疗胆囊结石合并胆总管结石疾病中的临床应用。

方法

回顾性分析惠州市中心人民医院2010年1月至2015年12月收治的184例胆囊结石合并胆总管结石患者的临床资料，按照手术方式不同分为两组，LC＋LCBDE组(59例)和ERCP/S＋LC组(125例)，比较分析两组患者的住院时间、住院费用，结石取净率、并发症发生率、中转开腹率。

结果

两组患者的住院时间、住院费用存在显著性差异[(13.12 ± 6.47)d vs (11.40 ± 6.83)d、(27 956.24 ± 9 896.90)元vs (35 381.35 ± 8 571.20)元，P<0.05]；但是两组患者术后住院时间无显著性差异。LC＋LCBDE组的住院时间长于ERCP＋LC组，住院费用低于ERCP/S＋LC组，并发症发生率、但结石清除率、中转开腹率两组无明显差异。

结论

对于胆囊结石合并胆总管结石，LC＋LCBDE与ERCP/S都是安全有效的手术方式。但两者皆需改进。LC＋LCBDE需要减少住院时间，ERCP/S＋LC需要减少住院费用。

关键词: 腹腔镜胆囊切除术, 腹腔镜胆总管探查切开取石术, 内镜下逆行性胆胰管造影术, 内镜下括约肌切开取石术

Objective

To compare therapeutic effects of laparoscopic cholecystectomy plus laparoscopic common bile duct exploration(LC+ LCBDE) and endoscopic retrograde cholangiopancreatography(ERCP)and sphincterotomy (EST) with stone extraction plus laparoscopic cholecystectomy(ERCP/S+ LC) in treating cholecystolithiasis with choledocholithiasis.

Methods

From Jan. 2010 to Dec.2015, 184 patients with cholecystolithiasis and choledocholithiasis were admitted to our hospital. According to different surgical procedure, they were divided into two groups: LC+ LCBDE group with 59 patients and ERCP/S+ LC group with 125 patients. Several indexes including hospital stay time, hospital charges, rate of complications, efficacy of stone clearance, rate of conversion to open procedures were comparatively analyzed in these two groups.

Results

There was statistically significant difference between the LC+ LCBDE and ERCP/S+ LC groups in total hospital stay time and total hospital charges[(13.12 ± 6.47)d vs (11.40 ± 6.83)d, (27 956.24 ± 9 896.90)yuan vs (35 381.35 ± 8 571.20)yuan, P< 0.05]. But there was no statistically significant difference in postoperative hospital stay time and efficacy of stone clearance, rate of complications, and rate of conversion to open procedures. The total hospital stay time of LC+ LCBDE group was longer than that of ERCP/S+ LC group. And the total hospital charges of LC+ LCBDE group was less than that of ERCP/S+ LC group.

Conclusions

Both LC+ LCBDE and ERCP/S+ LC were safe and effective in treating cholecystolithiasis with choledocholithiasis. There was little advantage for LC+ LCBDE with the routine placement of T tube in common bile duct compared with ERCP/S+ LC. But both procedure need improvement. LC+ LCBDE procedure need decrease its total hospital stay time and ERCP/S+ LC procedure need decrease its total hospital charges.

Key words: Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration and stone extraction, Endoscopic retrograde cholangiopancreatography, Endoscopic Sphincterotomy with stone extraction

表1 胆囊结石合并胆总管结石患者的两组临床资料比较

组别	例数	性别(男性/女性，例)	年龄(岁)	黄疸(例)
组别	例数	性别(男性/女性，例)	年龄(岁)	>34.2 μmol/L	≤34.2μmol/L
LC＋LCBDE组	59	25/34	26～84	40	19
ERCP/S＋LC组	125	55/70	23～87	90	35

表1 胆囊结石合并胆总管结石患者的两组临床资料比较

组别	例数	性别(男性/女性，例)	年龄(岁)	黄疸(例)
组别	例数	性别(男性/女性，例)	年龄(岁)	>34.2 μmol/L	≤34.2μmol/L
LC＋LCBDE组	59	25/34	26～84	40	19
ERCP/S＋LC组	125	55/70	23～87	90	35

表2 胆囊结石合并胆总管结石患者的两组临床指标比较

组别	例数	总住院时间(d， ±s)	术后住院时间(d， ±s)	总住院费用(元， ±s)	术后并发症[例(%)]	结石取净[例(%)]	中转开腹[例(%)]
LC＋LCBDE组	59	20.17 ± 9.14	13.12 ± 6.47	27 956.24 ± 9 896.90	6(10.17)	56(94.91)	2(3.39)
ERCP/S＋LC组	125	16.59 ± 7.35	11.40 ± 6.83	35 381.35 ± 8 571.20	13(10.40)	121(96.8)	3(2.40)
P值	?	0.005	0.162	0.000	0.806	0.656	0.656

表2 胆囊结石合并胆总管结石患者的两组临床指标比较

组别	例数	总住院时间(d， ±s)	术后住院时间(d， ±s)	总住院费用(元， ±s)	术后并发症[例(%)]	结石取净[例(%)]	中转开腹[例(%)]
LC＋LCBDE组	59	20.17 ± 9.14	13.12 ± 6.47	27 956.24 ± 9 896.90	6(10.17)	56(94.91)	2(3.39)
ERCP/S＋LC组	125	16.59 ± 7.35	11.40 ± 6.83	35 381.35 ± 8 571.20	13(10.40)	121(96.8)	3(2.40)
P值	?	0.005	0.162	0.000	0.806	0.656	0.656

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Clinical study of LC+ LCBDE and ERCP/S+ LC in treating cholecystolithiasis wtih choledocholithiasis

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Clinical study of LC+ LCBDE and ERCP/S+ LC in treating cholecystolithiasis wtih choledocholithiasis