三镜联合治疗胆囊结石合并胆总管结石临床疗效及预后分析

doi:10.16139/j.1007-9610.2021.03.016

摘要/Abstract

摘要：

目的：比较腹腔镜胆囊切除术（laparoscopic cholecystectomy, LC）联合胆总管探查术（腹腔镜、胆管镜和十二指肠镜三镜联合治疗）与内镜十二指肠乳头括约肌切开术（endoscopic sphincterotomy, EST）联合LC治疗胆囊结石合并胆总管结石老年病人（≥65岁）的临床疗效。方法：回顾性分析我院2018年3月至2019年6月收治的60例胆总管直径≥10 mm的胆囊结石合并胆总管结石的老年病人,其中35例行LC联合胆总管探查一期缝合胆总管支架置入,25例行EST+LC,比较两组治疗情况。结果：病人术后住院时间以及胰腺炎、胆道出血、肺部感染以及结石复发、胆道感染,两组差异均无统计学意义,但手术时间、住院费用、术后高淀粉酶血症等方面差异具有统计学意义。结论：对于胆囊结石合并胆总管结石的老年病人,可行LC、胆总管切开取石,并置入胆总管支架,胆总管一期缝合,疗效显著,优于EST+LC。

关键词: 胆总管结石, 腹腔镜, 胆总管探查术, 内镜十二指肠乳头括约肌切开术, 胆道支架

Abstract:

Objective To compare the clinical effects on elderly patients suffered from gallbladder stones associated with choledocholithiasis between the group of laparoscopic cholecystectomy(LC) with common bile duct exploration (LCBDE) using three scopys including laparoscopy, cholangioscopy and duodenoscopy and the group of endoscopic sphincterotomy(EST) with LC. Methods Sixty elderly patients more than 65 years with stones in gallbladder and common bile duct had common bile duct diameter 10 mm and more in our hospital between March 2018 and June 2019 and were analyzed retrospectively. Thirty-five cases had LC and LCBDE with primary duct closure combined with biliary stent. Twenty-five cases were treated EST with LC. Clinical effects were compared between two groups. Results There was no significant difference in postoperative hospital stay, pancreatitis, biliary bleeding, pulmonary infection and stone recurrence, biliary tract infection between two groups. However, the differences were significant in operative time, hospital cost and postoperative hyperamylasemia between two groups. Conclusions The stones in gallbladder and common bile duct in elderly patients could be treated by LC, LCBDE and primary duct closure combined with biliary stent, which had better clinical effects when compared to EST and LC.

Key words: Choledocholithiasis, Laparoscopy, Common bile duct exploration, Endoscopy sphincterotomy, Biliary stent

中图分类号:

R657.42

章波, 黄侠. 三镜联合治疗胆囊结石合并胆总管结石临床疗效及预后分析[J]. 外科理论与实践, 2021, 26(03): 254-258.

ZHANG Bo, HUANG Xia. Clinical effect and prognosis analysis of laparoscopic cholecystectomy combined with cholangioscopy and duodenoscopy in treatment of gallbladder stones associated with choledocholithiasis[J]. Journal of Surgery Concepts & Practice, 2021, 26(03): 254-258.

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项目	LCBDE+LC 组(n=35)	EST+LC组 (n=25)	t/χ²值	P值
平均年龄(岁)	74.0±8.2	72.0±7.1	0.892	0.376
性别			2.800	0.094
男	12（34.2）	14（56.0）
女	23（65.7）	11（44.0）
胆总管平均直径(cm)	1.27±0.27	1.21±0.22	0.836	0.407
结石平均直径(cm)	0.87±0.40	0.89±0.20	-0.161	0.873
结石数目			0.008	0.930
单发	15（42.8）	11（44.0）
多发	20（57.1）	14（56.0）
黄疸	14（40.0）	11（44.0）	0.096	0.757
合并症
高血压	8（22.8）	8（32.0）	0.632	0.430
糖尿病	5（14.2）	5（20.0）	0.343	0.558

项目	LCBDE+LC组 (n=35)	EST+LC组 (n=25)	χ²值	P值
肺部感染	1	1	0.059	0.808
胆道出血	0	1	1.424	0.233
高淀粉酶血症	0	6	9.333	0.002
胰腺炎	1	0	0.726	0.394

项目	LCBDE+LC组(n=35)	EST+LC组(n=25)	t值	P值
手术时间(min)	94.57±27.92	117.60±27.46	-3.170	0.02
住院时间(d)	6.71±2.08	5.92±1.38	1.663	0.102
住院费用(元)	34 870±3 858	52 250±4 489	-16.06	<0.001

项目	LCBDE+LC组(n=35)	EST+LC组(n=25)	χ²值	P值
结石复发	1	2	0.812	0.368
胆道感染	1	3	1.959	0.162