摘要
目的探讨腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查术(LCBDE)与ERCP(经内镜逆行性胰胆管造影)/EST(乳头括约肌切开取石术)+LC治疗胆囊结石合并胆总管结石的临床效果。方法选取2020年8月—2022年12月来本院就诊且确诊为胆囊结石合并胆总管结石的80例患者进行研究,采用随机数字表法将其分为LC+LCBDE组与ERCP/EST+LC组,每组40例,前组采用LC+LCBDE术治疗,后组采用ERCP/EST+LC术治疗,对比两组患者临床治疗效果、术中及术后相关指标、术后并发症发生率。结果两组结石清除率、结石残留率及中转开腹率对比无显著差异(P>0.05);与ERCP/EST+LC组比较,LC+LCBDE组术后住院时间更短,且住院费用更低(P<0.05);与LC+LCBDE组比较,ERCP/EST+LC组手术时间更短、术中出血量更少,术后排气时间更早(P<0.05);LC+LCBDE组胆漏发生率高于ERCP/EST+LC组,但胰腺炎发生率低于ERCP/EST+LC组(P<0.05),两组其他并发症发生率对比差异无统计学意义(P>0.05)。结论胆囊结石合并胆总管结石选择LC+LCBDE与ERCP/EST+LC术治疗均可取,但不同术式有其明显的优势与不足,其中LC+LCBDE术后住院时间更短,且住院费用更低,但发生胆漏风险更高,而ERCP/EST+LC术手术时间更短、术中出血量更少,术后排气时间更早,但术后发生胰腺炎的风险更高。
Objective To investigate clinical effect of laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration(LCBDE)and ERCP(endoscopic retrograde cholangiopancreatography)/EST(papillary Sphincter lithotomy)+LC in treatment of cholecystolithiasis combined with choledocholithiasis.Methods The paper chose 80 patients diagnosed with cholecystolithiasis combined with choledocholithiasis in our hospital from August 2020 to December 2022,and divided them into two groups with random number table method,namely LC+LCBDE group and ERCP/EST+LC group,with 40 cases in each group.The former group was treated with LC+LCBDE surgery,while the latter with ERCP/EST+LC surgery.Clinical treatment effect,intraoperative and postoperative related indicators and postoperative complication rate between two groups were compared.Results There was no significant difference in stone clearance rate,stone residue rate,and conversion rate between two groups(P>0.05).LC+LCBDE group had shorter postoperative length of stay and lower hospitalization costs than ERCP/EST+LC group(P<0.05).ERCP/EST+LC group had shorter surgical time,less intraoperative bleeding,and earlier postoperative exhaust time than LC+LCBDE group(P<0.05).Incidence of bile leakage in LC+LCBDE group was higher than ERCP/EST+LC group,but incidence of pancreatitis was lower than ERCP/EST+LC group(P<0.05).There was no statistically significant difference in incidence of other complications between two groups(P>0.05).Conclusion Both LC+LCBDE and ERCP/EST+LC are recommended for treatment of cholecystolithiasis combined with choledocholithiasis,different surgical methods have particularly obvious advantages and disadvantages.LC+LCBDE has shorter postoperative length of stay and lower hospitalization costs,but has higher risk of biliary leakage.ERCP/EST+LC has shorter surgical time,less intraoperative bleeding,earlier postoperative exhaust time,but higher risk of postoperative pancreatitis.
作者
张鑫
王岩
孙继盛
马立恒
景晖
ZHANG Xin;WANG Yan;SUN Jisheng;MA Liheng;JING Hui(General Surgery Department No.1,Hexi University Affiliated Zhangye People's Hospital,Zhangye,Gansu 734000)
出处
《智慧健康》
2023年第22期122-126,共5页
Smart Healthcare
基金
2021年度甘肃省高等学校创新基金项目任务书《三镜联合治疗胆石症的临床效果对比分析及经验总结》(项目编号:2021B-229)。
关键词
胆囊结石
胆总管结石
腹腔镜胆囊切除术
腹腔镜胆总管探查术
Cholecystolithiasis
Choledocholithiasis
Laparoscopic cholecystectomy
Laparoscopic common bile duct exploration
