腹腔镜联合内镜同期治疗胆囊结石合并胆总管结石疗效分析

Comparison of curative effect of ERCP+LC and LC+LCBDE for Cholecystolithiasis with Choledocholithiasis

摘要:

目的 评价腹腔镜胆囊切除术（LC）联合内镜胆总管取石、胆道支架置入及胆总管Ⅰ期缝合治疗胆囊结石合并胆总管结石的疗效及安全性。方法 2015年1月—2018年1月，因胆囊结石伴胆总管结石于包头医学院第二附属医院住院治疗的104例病例纳入回顾性分析，按治疗方法不同分成4组,A组（n=29）:先行经内镜逆行胰胆管造影取石，再行LC；B组（n=29）:行LC+胆道镜胆总管取石+T管引流；C组（n=17）:行LC+胆道镜胆总管取石+胆总管Ⅰ期缝合；D组（n=29）:行LC+胆道镜胆总管取石+胆道支架置入+胆总管Ⅰ期缝合。对手术时间、排气时间、并发症、住院天数、住院费用及结石残留率、结石复发率进行统计分析。结果 手术时间、排气时间、住院时间及胆总管结石复发率，4组间比较差异均无统计学意义（P均＞0.05）。胆瘘发生率4组间比较差异有统计学意义，其中C组明显高于其他3组（P均＜0.05），A、B、D组间两两比较差异均无统计学意义（P均＞0.05）。住院费用4组间比较差异有统计学意义，其中A组明显高于其他3组（P均＜0.05），B、C、D组间两两比较差异均无统计学意义（P均＞0.05）。结论 LC联合胆道镜胆总管取石、胆道支架置入及胆总管Ⅰ期缝合治疗胆囊结石合并胆总管结石安全、有效，在避免患者遭受二次手术打击的同时，并不会明显延长手术时间、住院天数，也不会明显增加住院费用，而且可以有效减少胆瘘的发生。

Abstract:

Objective To probe into the comparison of curative effect of ERCP+LC and LC+LCBDE for Cholecystolithiasis with Choledocholithiasis. Methods A retrospective analysis was conducted between January 2015 and January 2018 in patients who were suffered from Cholecystolithiasis with Choledocholithiasis were divided into four groups. The patients of group A who were 29 cases were operated with ERCP and EST firstly, and then were operated with LC. The patients of group B who were 29 cases were operated with LC and LCBDE, and then T tube was imbedded in the Choledocholithiasis. The patients of group C who were 17 cases were operated with LC and LCBDE, the Choledocholithiasis was satured directly after the removal of the stone. The patients of group D who were 29 cases were operated with LC and LCBDE, finished with biliary stent imbedded and common bile duct sutured at the same time. The time of operation, intraoperative blood loss, hospital stay, hospitalization expenses, evacuation time, postoperative biliary fistula, the rate of postoperative residual stone and the rate of postoperative calculi recurrence were compared between four groups. Results The hospitalization expenses of group D were less obviously than group A(P<0.05). But the time of operation, hospital stay , intraoperative blood loss, hospitalization expenses of group D has no statistical differences(P>0.05) with group B and C. The occurrence rate of postoperative biliary fistula of group D was lower than group C(P<0.05). Conclusion The application of biliary stent after LC and LCBDE with laparoscopy combined with cholecystectomy not only will not prolong the operation time and hospital stay, Increase hospitalization expenses, but also prevent the occurrence of pancreatitis and biliary fistula, and avoid the need for a second surgical procedure.