两种手术方式治疗胆囊结石合并胆总管结石的疗效对比

Comparison of Two Surgical Methods for the Treatment of Cholecystolithiasis Combined with Choledocholithiasis

摘要: 目的：通过收集接受LCBDE + LC和ERCP/EST + LC的患者的临床资料进行分析，比较两种手术方式在治疗胆囊结石合并胆总管结石的安全性，可行性和经济性。方法：整理2019~2020年就诊于新疆军区总医院，确认为胆囊结石合并胆总管结石，而且可进行ERCP/EST + LC以及LCBDE + LC治疗，总计有142例，依据相关手术形式可划分为ERCP/EST + LC组(58例)，即为研究之中的内镜组，以及LCBDE + LC组(84例)即为研究之中的腔镜组。系统研究两个组别的基础资料、手术状况、化验指标、并发症以及住院状况。结果：两个组别的术前基础资料有符合要求的可比性(P > 0.05)，术前指标的区别较小不具备统计价值(P > 0.05)；LCBDE + LC组的手术时长以及出血显著更高(P < 0.05)；术后化验指标对比区别较小不具备统计价值(P > 0.05)；腔镜组治疗费用和总住院时间显著低于内镜组(P < 0.05)；两组患者术后并发症发生率，ERCP + LC组共有12例(20.69%)患者发生出血，胰腺炎，胆管炎，结石复发等并发症，而LCBDE + LC组总计存在8例(9.52%)出血，感染，胆漏等相关并发问题，两组并发症的区别较小不具备统计价值(P > 0.05)。结论：两类手术方法都有良好的治疗效果，两种手术方式均有着良好的可行性和安全性，LCBDE + LC较ERCP/EST + LC有着更好的经济性。针对患者的自身情况，制定个体化诊疗方案，让患者获益最大化，已成为目前外科医师追求的重大目标。

Abstract: Objective: To analyze the clinical data of patients receiving LCBDE + LC and ERCP/EST + LC, and compare the safety, feasibility, and economy of two surgical methods in the treatment of Cholecysto-lithiasis combined with Choledocholithiasis. Method: A total of 142 patients who were diagnosed with Cholecystolithiasis combined with Choledocholithiasis from 2019 to 2020 at the General Hos-pital of Xinjiang Military Region and were eligible for ERCP/EST + LC and LCBDE + LC treatment were classified into the ERCP/EST + LC group (58 cases) based on the relevant surgical procedures, which was the endoscopic group in the study, and the LCBDE + LC group (84 cases), which was the endoscopic group in the study. Systematically study the basic information, surgical status, labora-tory indicators, complications, and hospitalization status of two groups. Result: The preoperative basic data of the two groups were comparable to the requirements (P > 0.05), and the differences in preoperative indicators were small and did not have statistical value (P > 0.05); the surgical dura-tion and bleeding were significantly higher in the LCBDE + LC group (P < 0.05); the difference in postoperative laboratory indicators is small and does not have statistical value (P > 0.05); the treatment cost and total hospital stay in the endoscopic group were significantly lower than those in the endoscopic group (P < 0.05); the incidence of postoperative complications in the ERCP + LC group was 12 cases (20.69%), with complications such as bleeding, pancreatitis, cholangitis, and stone recurrence, while in the LCBDE + LC group, there were a total of 8 cases (9.52%) with related complications such as bleeding, infection, and bile leakage. The difference in complications between the two groups was small and did not have statistical value (P > 0.05). Conclusion: Both types of surgical methods have good therapeutic effects, and both have good feasibility and safety. LCBDE + LC has better economic efficiency than ERCP/EST + LC. Developing personalized diagnosis and treatment plans tailored to the individual situation of patients and maximizing their benefits has become a major goal pursued by surgeons at present.