胆囊切除术后胆总管结石手术方式的选择分析

Selection of Operative Methods for Common Bile Duct Stones after Cholecystectomy

摘要: 目的：比较经腹腔镜胆总管切开取石术(LCBDE)术中联合胆道镜与内镜下逆行胰胆管造影术(ERCP)及Oddi括约肌切开取石术(EST)治疗胆囊切除术后胆总管结石的疗效，对此类胆总管结石患者手术方式的选择提供依据。方法：选取胆囊切除术后胆总管结石患者临床资料120例，其中采用经腹腔镜下胆总管切开取石术患者60例，ERCP/EST取石术患者60例，比较两种手术方式治疗胆总管结石的成功率、手术时间、术中出血、平均住院时间、术后并发症及平均住院费用等指标。结果：两组患者在性别、年龄、合并基础疾病等术前相关指标无统计学差异(P > 0.05)。LCBDE组与ERCP/EST组患者取石成功率(95.0% VS 93.3%)，术中出血量[(40.36 ± 8.45) ml VS (30.25 ± 6.25) m]等比较无统计学意义(P > 0.05)；ERCP/EST组在手术时间[(45.73 ± 13.25) min VS (155.36 ± 23.25) min]及平均住院时间[(9.23 ± 1.78) d VS (13.25 ± 2.36) d]上要优于LCBDE组(P < 0.05)，但ERCP/EST组术后并发症(30% VS 1%)及平均住院费用[(23.125 ± 1.23 VS 14.849 ± 1.84)千元]要高于LCBDE组，差异有统计学意义(P < 0.05)。结论：两组手术方式均能够安全、有效治疗胆总管结石，ERCP在手术时间、术后住院时间方面较LCBDE有明显优势，但对于年轻病人及结石较大的病人LCBDE是更好的选择，但选择哪种手术方式需要根据患者身体情况及经济条件制定个体化方案。

Abstract: Objective: To compare the efficacy of Laparoscopic common bile duct exploration (LCBDE) combined with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy of Oddi (EST) in the treatment of common bile duct stones after cholecystectomy, to provide the basis for the choice of surgical methods in patients with common bile duct stones. Methods: The clinical data of 120 patients of common duct bile stones after cholecystectomy treated with LCBDE (n = 60) and ERCP/EST (n = 60) were retrospectively analyzed. The success rate, operation time, intra-operative bleeding, the average of hospital stay, postoperative complications and average hospitalization expense of the two operations were compared. Results: Between LCBDE and ERCP/EST group, there was no significant difference in terms of sex, age , basic diseases before Operation, the successful rate of stone remova (95.0% VS 93.3%) and intra-operative bleeding (40.36 ± 8.45 ml VS 30.25 ± 6.25 ml) (P > 0.05). ERCP/EST group had shorter operative time [(45.73 ± 13.25) min VS (155.36 ± 23.25) min] and average length of hospital stay [(9.23 ± 1.78) d VS (13.25 ± 2.36) d] than LCBDE Group (P < 0.05), but the postoperative complications (30% VS 1%) and the average hospitalization expenses (23.125 ± 1.23 VS 14.849 ± 1.84) thousand yuan) were significantly higher than LCBDE Group (P < 0.05). Conclusions: Both LCBDE and ERCP are safe and effective method for the treatment of common bile duct stones. ERCP has obvious advantages over LCBDE in terms of operative time and postoperative hospital stay, but for younger patients with large stones, LCBDE is a better choice, however, the clinical treatment should be individualized according to the patient’s own and economic conditions.