三种不同术式治疗胆囊并胆总管结石的近期随访评价

doi:10.3877/cma.j.issn.1674-3946.2019.04.030

目的

评价内镜逆行胰胆管造影(ERCP)＋镜下十二指肠乳头括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)、LC联合腹腔镜胆总管探查术(LCBDE)与传统开腹术治疗胆囊并胆总管结石的近期随访。

方法

回顾性分析2014年5月至2018年4月224例胆囊并胆总管结石患者，按照患者接受的手术方式不同，分为A组(ERCP/EST联合LC，84例)、B组(LC联合LCBDE，76例)、C组(开腹术，64例)。数据处理应用统计学软件SPSS 22.0完成。术后并发症发生率、结石残留率及复发率比较采用2检验；手术相关指标比较采用F检验，数据用(±s)来表示；P<0.05差异有统计学意义。

结果

三组患者手术时间、术后禁食天数、肛门排气时间、住院时间的差异均具有统计学意义(均P<0.05)，其中A组及B组上述指标均优于C组(均P<0.05)。A、B、C三组患者术后并发症发生率分别为6.0%、1.3%、12.5%(χ²＝7.1110, P<0.05)；三组患者术后6个月结石残留率及复发率的差异均无统计学意义(均P>0.05)。

结论

ERCP/EST联合LC、LC联合LCBDE治疗胆囊并胆总管结石的术后禁食天数、住院时间均较短，手术并发症发生率较低，二者均是安全可靠的手术方式，而LC联合LCBDE的疗效相对更为显著，可根据患者的自身情况选取合适的治疗方式。

关键词: 胆总管结石, 胆囊结石病, 腹腔镜, 胆囊切除术，腹腔镜, 胆囊切除术, 胰胆管造影术，内窥镜逆行

Objective

To evaluate the recent effect of endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC), laparoscopic cholecystectomy (LC) combined with Laparoscopic common bile duct exploration (LCBDE) and conventional laparotomy for the treatment of gallstones and common bile duct stones.

Methods

From May 2014 to April 2018, 224 patients with gallstones and common bile duct stones were selected and analyzed retrospectively. According to the different surgical methods, they were divided into group A(ERCP/EST combined with LC, 84 cases), group B (LC combined with LCBDE, 76 cases), group C (Traditional laparotomy, 64 cases). Statistical software SPSS 22.0 was used to analyze. The complication rate, calculus residual rate and recurrence rate were compared by χ² test. The surgical data were expressed as (±s) and compared with F test; P<0.05 was statistically significant.

Results

The differences of operation time, postoperative fasting days, anus exhaust time and hospitalization time were statistically significant among the three groups (all P<0.05). The above indicators in group A and group B were better than those in group C (all P<0.05). The incidence of postoperative complications in group A, B, and C was 6.0%, 1.3%, and 12.5%, respectively, there was a statistically significant difference among the three groups (χ²=7.1110, P<0.05). There was no significant difference in the rate of residual stones and recurrence rate at 6 months after surgery between the three groups (all P>0.05).

Conclusion

Postoperative fasting days and shorter hospitalization time were shorter in both ERCP/EST combined with LC, LC and LCBDE for the treatment of gallbladder and common bile duct stones, and the incidence of surgical complications is low, they are safe and reliable surgical methods, but the effect of LC combined with LCBDE is relatively better, and the appropriate treatment can be selected according to the patient’s own conditions.

Key words: Choledocholithiasis, Cholecystolithiasis, Laparoscopes, Cholecystectomy, laparoscopic, Cholecystectomy, Cholangiopancreatography, endoscopic Retrograde

表1 224例胆囊结石合并胆总管结石患者不同术式三组患者在基本资料比较(±s)

组别	例数	年龄(岁)	性别(例)	胆红素(μmol/L)	结石数目(枚)
组别	例数	年龄(岁)	男/女	胆红素(μmol/L)	结石数目(枚)
A组	84	56.4±10.8	49/35	122.4±14.8	2.8±0.8
B组	76	57.4±9.6	44/32	121.8±13.9	2.9±0.8
C组	64	54.4±11.1	39/25	120.7±14.6	2.9±0.7
χ²/F值	?	0.5234	0.1526	0.8239	0.7842
P值	?	>0.05	>0.05	>0.05	>0.05

表1 224例胆囊结石合并胆总管结石患者不同术式三组患者在基本资料比较(±s)

组别	例数	年龄(岁)	性别(例)	胆红素(μmol/L)	结石数目(枚)
组别	例数	年龄(岁)	男/女	胆红素(μmol/L)	结石数目(枚)
A组	84	56.4±10.8	49/35	122.4±14.8	2.8±0.8
B组	76	57.4±9.6	44/32	121.8±13.9	2.9±0.8
C组	64	54.4±11.1	39/25	120.7±14.6	2.9±0.7
χ²/F值	?	0.5234	0.1526	0.8239	0.7842
P值	?	>0.05	>0.05	>0.05	>0.05

表2 224例胆囊结石合并胆总管结石患者不同术式三组患者手术相关指标比较(±s)

组别	例数	手术时间(min)	术后禁食天数(d)	肛门排气时间(d)	住院时间(d)
A组	84	164.4±25.1^a	2.2±0.6^a	2.3±1.0^a	11.2±3.2^a
B组	76	152.4±18.2^a	2.0±0.7^a	2.1±1.1^a	10.1±3.5^a
C组	64	222.4±34.2	3.7±0.8	3.8±1.4	18.9±3.7
F值	?	12.4537	5.3729	4.1235	6.5743
P值	?	<0.05	<0.05	<0.05	<0.05

表2 224例胆囊结石合并胆总管结石患者不同术式三组患者手术相关指标比较(±s)

组别	例数	手术时间(min)	术后禁食天数(d)	肛门排气时间(d)	住院时间(d)
A组	84	164.4±25.1^a	2.2±0.6^a	2.3±1.0^a	11.2±3.2^a
B组	76	152.4±18.2^a	2.0±0.7^a	2.1±1.1^a	10.1±3.5^a
C组	64	222.4±34.2	3.7±0.8	3.8±1.4	18.9±3.7
F值	?	12.4537	5.3729	4.1235	6.5743
P值	?	<0.05	<0.05	<0.05	<0.05

表3 224例胆囊结石合并胆总管结石患者不同术式三组患者术后并发症发生情况比较[例(%)]

组别	例数	胆管出血	切口感染	腹腔感染	胰腺炎	总发生率
A组	84	1(2.4)	2(2.4)	1(1.2)	1(1.2)	5(6.0)
B组	76	0(0.0)	1(1.3)	0(0.0)	0(0.0)	1(1.3)^a
C组	64	1(1.6)	4(6.3)	2(3.1)	1(1.6)	8(12.5)

表3 224例胆囊结石合并胆总管结石患者不同术式三组患者术后并发症发生情况比较[例(%)]

组别	例数	胆管出血	切口感染	腹腔感染	胰腺炎	总发生率
A组	84	1(2.4)	2(2.4)	1(1.2)	1(1.2)	5(6.0)
B组	76	0(0.0)	1(1.3)	0(0.0)	0(0.0)	1(1.3)^a
C组	64	1(1.6)	4(6.3)	2(3.1)	1(1.6)	8(12.5)

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Recent follow-up evaluations of three different surgery methods in the treatment of gallbladder and common bile duct stones

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Recent follow-up evaluations of three different surgery methods in the treatment of gallbladder and common bile duct stones