胆囊结石合并胆总管结石时的一期治疗临床研究：术中ERCP与腹腔镜胆总管探查术的比较

doi:10.16139/j.1007-9610.2020.01.014

摘要/Abstract

摘要：

目的： 研究胆囊结石合并胆总管结石的两种一期治疗方式。将腹腔镜胆囊切除术（LC）+术中内镜逆行胰胆管造影术（ERCP）作为ERCP组; LC+腹腔镜胆总管探查术（LCBDE）作为LCBDE组,对两种治疗方法进行比较。方法： 回顾性分析2017年1月至2018年12月,我院收治的胆囊结石合并胆总管结石病人189例,其中ERCP组111例,LCBDE组78例,通过临床指标比较,评价两种方法的疗效、安全性及经济性。结果： 两组病人在性别、年龄、BMI、ASA分级、术前检查指标的差异均无统计学意义（P>0.05）。两组结石取净率和术后并发症发生率的差异无统计学意义（P>0.05）。在病人的选择上,LCBDE组适应证范围较广,既往胃部手术史例数多,结石较大。ERCP组住院时间较短[（6.79±2.78） d比（13.18±5.43） d,P<0.01],术后恢复较快,但住院总费用较高[（35 746.86±7 048.23）元比（30 422.74±8 698.72）元,P<0.01]。结论： LC+术中ERCP与LC+LCBDE两种微创一期手术处理胆囊结石合并胆总管结石安全、有效。LC+术中ERCP能处理大多数病例,尽管费用高,但恢复快。LC+LCBDE在既往胃部手术史及较大结石的病例中具有优势。

关键词: 胆总管结石, 腹腔镜, 内镜逆行胰胆管造影术, 胆总管探查术

Abstract:

Objective To compare two approaches of single-stage of treating concomitant gallbladder stones and common bile duct stones. Laparoscopic cholecystectomy (LC) was performed with endoscopic retrograde cholangiography (ERCP) as ERCP group and LC combined with laparoscopic common bile duct exploration (LCBDE) as LCBDE group. Intraoperative ERCP was compared with LCBDE. Methods Retrospective analysis was performed for 189 patients with concomitant gallbladder stones and common bile duct stones in our hospital from January 2017 to December 2018. A total of 111 cases were in ERCP group using LC with ERCP and 78 cases in LCBDE group using LC with LCBDE. The efficacy, safety and economy of two approaches were investigated. Results No statistical significance was present between two groups in gender, age, BMI, ASA grade, and preoperative examination (P>0.05). Significant difference was not found in stone clearance rate and postoperative complications(P>0.05). The cases in LCBDE group had wider indication with more patients of gastric surgery history and larger stones. The cases in ERCP group had less hospital days (6.79±2.78 d vs. 13.18±5.43 d, P<0.01), faster postoperative recovery, but higher total cost of hospitalization (35 746.86±7 048.23 Yuan vs. 30 422.74±8 698.72 Yuan, P<0.01). Conclusions Both LC combined with ERCP and with LCBDE are safe and effective to treat gallbladder stones and common bile duct stones. LC with ERCP can treat most cases with faster postoperative recovery, although the cost is higher. LC with LCBDE has the advantages in cases with gastric surgery history and larger stones.

Key words: Common bile duct stones, Laparoscopy, Endoscopic retrograde cholangiography（ERCP）, Common bile duct exploration

中图分类号:

R657.42

王申捷, 毛志海, 郑民华. 胆囊结石合并胆总管结石时的一期治疗临床研究：术中ERCP与腹腔镜胆总管探查术的比较[J]. 外科理论与实践, 2020, 25(01): 65-68.

WANG Shenjie, MAO Zhihai, ZHENG Minhua. Clinical study on single-stage management for concomitant gallbladder stones and common bile duct stones: ERCP or laparoscopic exploration of common bile duct[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 65-68.

图/表 3

参考文献 12

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项目	ERCP组（n=111）	LCBDE组（n=78）	P值
性别			0.080
男	54	48
女	57	30
年龄（岁）	56.41±15.16	55.64±16.50	0.753
BMI			0.131
≥24	40	20
<24	71	58
ASA分级			0.518
1~2	72	47
3~4	39	31
肝功能异常			0.318
有	72	45
无	39	33
血常规异常			0.457
有	7	3
无	104	75
既往胃部手术史	0	5	<0.01

项目	ERCP组（n=111）	LCBDE组（n=78）	P值
结石数			0.223
单发	57	47
多发	54	31
结石直径（mm）	5.32±1.89	8.65±3.07	<0.01
胆总管直径（mm）	9.60±2.86	10.55±2.39	<0.01
结石取净率	97.3%（108/111）	94.8%（74/78）	0.625
并发症发生率	5.4%（6/111）	3.8%（3/78）	0.362

项目	ERCP组（n=111）	LCBDE组（n=78）	P值
住院时间（d）	6.79±2.78（3~19）	13.18±5.43（4~30）	<0.01
住院总费用（人民币：元）	35 746.86±7 048.23	30 422.74±8 698.72	<0.01

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