摘要
目的通过比较同期内镜逆行胰胆管造影(ERCP)联合腹腔镜下胆囊切除术(LC)和腹腔镜下胆囊切除胆总管探查取石术(LCBDE)对胆囊结石合并胆管结石患者的疗效,探讨两种术式治疗胆囊结石合并胆管结石的适应证。方法选取胆囊结石合并肝外胆管结石患者146例,依据手术方式分为同期ERCP+LC组(A组60例)和LCBDE组(B组86例),同期ERCP+LC组患者在实施ERCP后立即行LC术。比较2组手术中转开腹率、结石残留率、手术成功率、手术相关不良事件及全身并发症发生率、住院费用、住院总时间等指标差异。结果2组患者平均手术时长、平均手术出血量、手术相关不良事件发生比例、术后全身并发症发生比例均无统计学意义(P>0.05)。A组患者术后胰腺炎发生率6.7%,显著高于B组(P<0.05);A组患者平均住院花费为(38839.9±5549.5)元,平均住院时长(7.4±2.6)d,B组平均住院花费为(24635.9±9893.7)元,平均住院时长(9.9±3.7)d,A组平均住院花费显著高于B组,但平均住院时长低于B组(P<0.05)。A组患者中转开腹率为5.0%,B组为17.4%,2组比较差异有统计学意义(P<0.05)。B组患者最大胆管结石直径≥1 cm者占37.2%,结石数量≥3颗者占23.3%,显著高于A组(P<0.05)。结石直径<1 cm、结石数量<3颗的患者,A组手术成功率分别为93.8%、92.6%,均显著高于B组(P<0.05);结石数量≥3颗的患者,A组结石残留率高达33.3%,显著高于B组(P<0.05)。结论同期ERCP+LC术和LCBDE术均是治疗胆囊结石合并肝外胆管结石安全、有效的手术方式。
Objective To explore the indications of two surgical methods and to compare the effect of single-stage endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration plus cholecystectomy(LCBDE)on patients with concomitant gallstones and extrahepatic bile duct stones.Methods Patients with concomitant gallstones and extrahepatic bile duct stones in our hospital from January 2015 to June 2019 were enrolled in the study,and the patients were divided into ERCP+LC group(group A)and LCBDE group(group B).Patients in group A underwent LC immediately after ERCP.The difference in the proportion of conversion to laparotomy,the proportion of stone residual,the success rate of surgery,the proportion of adverse events related to surgery,the incidence of systemic complications,hospitalization expenses,and total length of stay between the two groups were compared.Results A total of 146 patients were enrolled in this study,including 60 patients in group A and 86 patients in group B.There was no significant difference between the two groups in terms of average operation time,average surgical blood loss,incidence of surgery-related adverse events,and incidence of postoperative systemic complications(P>0.05).The incidence of postoperative pancreatitis in group A was 6.7%,which was significantly higher than that in group B(0%,P<0.05);the incidence of bile leakage in group B was 3.5%,and there was no bile leakage in group A,but the difference was not statistically significant(P>0.05).The average hospitalization cost of group A was 3,8839.9±5549.5 Yuan,and the average length of stay was 7.4±2.6 days.The average hospitalization cost of group B was 24635.9±9893.7 Yuan,and the average length of stay was 9.9±3.7 days.The average hospitalization cost of group A was significantly higher than that of group B,but the average length of hospital stay was lower than that of group B(P<0.05).The conversion rate to laparotomy was 5.0%in group A and was 17.4%in group B,the difference was statistically significant(P>0.05).There was no significant difference in the overall stone residual rate(group A 5.0%,group B 2.3%)and the success rate of surgery(group A 90.0%,group B 80.2%)between the two groups(P>0.05).However,the bile duct stones size≥1 cm accounted for 37.2%of patients,and stones number≥3 accounted for 23.3%in group B,both of which accounted for significantly higher proportions than group A(P<0.05).Considering those offset factors,for patients with stones size<1cm and stones number<3,the success rates of surgery in group A were 93.8%and 92.6%,respectively,which were significantly higher than those in group B(P<0.05);but patients with stones number≥3,the rate of stone residual in group A was up to 33.3%,which was significantly higher than that in group B(P>0.05).Conclusion Both single stage ERCP+LC and LCBDE are safe and effective methods for the treatment of concomitant gallstones and extrahepatic bile duct stones.Compared with LCBDE,ERCP+LC has the advantages of faster recovery and lower conversion to laparotomy.For patients with bile duct stones size<1cm and stones number<3,ERCP+LC can increase the success rate of the operation,but for patients with bile duct stones number≥3,ERCP+LC has a higher stone residual rate.
作者
姚维杰
马泽
彭波
赵成思
金栋
张兴智
王佐正
YAO Weijie;Ma Ze;PENG Bo;ZHAO Chengsi;JIN Dong;ZHANG Xingzhi;WANG Zuozheng(Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of General Surgery,People's Hospital of Haiyuan,Zhongwei 755200,China;School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,China;Cardiovascular and Cerebrovascular Disease Hospital,General Hospital of Ningxia Medical University,Yinchuan 750002,China;Department of General Surgery,Yuanzhou District People's Hospital,Guyuan 756000,China)
出处
《宁夏医学杂志》
CAS
2021年第12期1076-1079,共4页
Ningxia Medical Journal
基金
宁夏医科大学校级项目(XZM2018145)
宁夏重点研发计划项目(2021BEG03042)
宁夏重点研发计划项目(2020BEG02002)
宁夏科技惠民计划项目(2021CMG03013)。
关键词
胆管结石
内镜逆行胰胆管造影
腹腔镜下胆管探查
ERCP
LCBDE
Neuroprotective effect Bile duct stones
Endoscopic retrograde cholangiopancreatography
Laparoscopic bile duct exploration
ERCP
LCBDE
