Comparison of the efficacy and impact on prognosis of endoscopic papillary sphincterotomy combined with balloon dilation and laparoscopic common bile duct exploration combined with LC in the treatment of common bile duct stones

doi:10.3877/cma.j.issn.1674-3946.2026.06.017

Abstract

Abstract:

Objective

To compare the short-term recovery trajectories and short-term prognosis differences between endoscopic sphincterotomy (EST) combined with endoscopic papillary balloon dilation (EPBD) and laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) in the treatment of common bile duct stones, and to provide evidence-based medical evidence for the individualized selection of treatment plans in clinical practice.

Methods

From December 2023 to December 2025, 306 patients with common bile duct stones and gallbladder stones were selected as the research subjects. The patients were divided into the endoscopic group (EST combined with EPBD + elective LC, n=120) and the laparoscopic group (LCBDE combined with LC, n=186). The propensity score matching (PSM) was used to balance the differences between the groups and reduce potential confounding factors. Then, t tests or χ² tests were used to compare the general information, efficacy-related indicators, perioperative indicators, and postoperative complication rates of the two groups of patients. Cox proportional hazards regression analysis was used to investigate the impact of treatment methods on the prognosis of patients.

Results

There was no statistically significant difference in the one-stage stone clearance rate between the two groups (P>0.05). There were statistically significant differences in the operation time, intraoperative blood loss, postoperative bed rest time, postoperative hospital stay, postoperative eating recovery time, visual analog scale (VAS) scores at 1, 3, and 7 days after surgery, serum amylase (AMS) levels at 1, 3, and 7 days after surgery, and C-reactive protein (CRP) levels at 1 d, 3 d, and 7 days after surgery between the two groups (P<0.05). Cox regression analysis showed that laparoscopic treatment was a protective factor for the short-term prognosis of patients with common bile duct stones (P<0.05). The stratified analysis results showed that in subgroups of age < 60 years, multiple stones, and the maximum stone diameter ≥ 10 mm, the prognosis of patients in the laparoscopic group was better than that in the endoscopic group (all P<0.05).

Conclusion

EST combined with EPBD has more advantages in reducing postoperative pain and reducing inflammatory response, but the short-term prognosis is poorer; LCBDE combined with LC has more advantages in protecting pancreatic function and improving short-term prognosis. Clinical decision-making should be based on the individual circumstances of patients and select the best treatment plan.

Key words: Choledocholithiasis, Endoscopic Sphincterotomy, Endoscopic Papillary Balloon Dilation, Laparoscopic Common Bile Duct Exploration, Cholecystectomy, Laparoscopic

Yueyu Qu, Hai Wang, Senlin Xiao, Jialin Yang, Yong Peng. Comparison of the efficacy and impact on prognosis of endoscopic papillary sphincterotomy combined with balloon dilation and laparoscopic common bile duct exploration combined with LC in the treatment of common bile duct stones[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(06): 586-592.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2026.06.017

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Figures/Tables 7

组别	例数	年龄（岁， $x ¯$ ±s）	性别（例）		BMI(kg/m²， $x ¯$ ±s)	SBP(mmHg， $x ¯$ ±s)	DBP(mmHg， $x ¯$ ±s)	RR(次/min， $x ¯$ ±s)	HR(次/min， $x ¯$ ±s)
组别	例数	年龄（岁， $x ¯$ ±s）	男	女	BMI(kg/m²， $x ¯$ ±s)	SBP(mmHg， $x ¯$ ±s)	DBP(mmHg， $x ¯$ ±s)	RR(次/min， $x ¯$ ±s)	HR(次/min， $x ¯$ ±s)
内镜组	110	57.2±12.8	48	62	24.8±3.1	127.6±14.9	78.2±9.3	18.2±1.7	76.2±8.3
腹腔镜组	110	56.6±12.6	51	59	24.8±3.4	127.3±15.1	78.1±9.6	18.1±1.7	76.1±8.5
统计值		t=0.357	χ²=0.165		t=0.161	t=0.188	t=0.117	t=0.174	t=0.094
P值		0.722	0.684		0.873	0.851	0.907	0.862	0.925
组别	病程（月， $x ¯$ ±s）	最大结石最大径（mm， $x ¯$ ±s）	结石数量（例）		吸烟史（例）		饮酒史（例）		基础疾病（例）
组别	病程（月， $x ¯$ ±s）	最大结石最大径（mm， $x ¯$ ±s）	单发	多发	是	否	是	否	是	否
内镜组	4.4±1.2	10.1±3.1	64	46	36	74	30	80	48	62
腹腔镜组	4.3±1.2	10.1±3.0	62	48	41	69	32	78	46	64
统计值	t=0.570	t=0.145	χ²=0.074		χ²=0.500		χ²=0.090		χ²=0.074
P值	0.569	0.885	0.785		0.480		0.764		0.785

组别	例数	年龄（岁， $x ¯$ ±s）	性别（例）		BMI(kg/m²， $x ¯$ ±s)	SBP(mmHg， $x ¯$ ±s)	DBP(mmHg， $x ¯$ ±s)	RR(次/min， $x ¯$ ±s)	HR(次/min， $x ¯$ ±s)
组别	例数	年龄（岁， $x ¯$ ±s）	男	女	BMI(kg/m²， $x ¯$ ±s)	SBP(mmHg， $x ¯$ ±s)	DBP(mmHg， $x ¯$ ±s)	RR(次/min， $x ¯$ ±s)	HR(次/min， $x ¯$ ±s)
内镜组	110	57.2±12.8	48	62	24.8±3.1	127.6±14.9	78.2±9.3	18.2±1.7	76.2±8.3
腹腔镜组	110	56.6±12.6	51	59	24.8±3.4	127.3±15.1	78.1±9.6	18.1±1.7	76.1±8.5
统计值		t=0.357	χ²=0.165		t=0.161	t=0.188	t=0.117	t=0.174	t=0.094
P值		0.722	0.684		0.873	0.851	0.907	0.862	0.925
组别	病程（月， $x ¯$ ±s）	最大结石最大径（mm， $x ¯$ ±s）	结石数量（例）		吸烟史（例）		饮酒史（例）		基础疾病（例）
组别	病程（月， $x ¯$ ±s）	最大结石最大径（mm， $x ¯$ ±s）	单发	多发	是	否	是	否	是	否
内镜组	4.4±1.2	10.1±3.1	64	46	36	74	30	80	48	62
腹腔镜组	4.3±1.2	10.1±3.0	62	48	41	69	32	78	46	64
统计值	t=0.570	t=0.145	χ²=0.074		χ²=0.500		χ²=0.090		χ²=0.074
P值	0.569	0.885	0.785		0.480		0.764		0.785

组别	例数	一期结石清除[例（%）]	手术时间（min， $x ¯$ ±s）	术中出血量（ml， $x ¯$ ±s）
内镜组	110	98(89.1)	48.5±12.6	9.2±3.1
腹腔镜组	110	104(94.5)	85.4±18.5	68.6±16.4
统计值		χ²=2.125	t=17.255	t=37.326
P值		0.145	<0.001	<0.001
组别	术后卧床时间（h， $x ¯$ ±s）	术后住院时间（d， $x ¯$ ±s）	术后恢复进食时间（h， $x ¯$ ±s）
内镜组	6.5±2.0	6.9±1.6	26.6±8.6
腹腔镜组	18.6±5.6	5.8±1.7	32.1±7.4
统计值	t=21.208	t=4.756	t=5.128
P值	<0.001	<0.001	<0.001

组别	例数	一期结石清除[例（%）]	手术时间（min， $x ¯$ ±s）	术中出血量（ml， $x ¯$ ±s）
内镜组	110	98(89.1)	48.5±12.6	9.2±3.1
腹腔镜组	110	104(94.5)	85.4±18.5	68.6±16.4
统计值		χ²=2.125	t=17.255	t=37.326
P值		0.145	<0.001	<0.001
组别	术后卧床时间（h， $x ¯$ ±s）	术后住院时间（d， $x ¯$ ±s）	术后恢复进食时间（h， $x ¯$ ±s）
内镜组	6.5±2.0	6.9±1.6	26.6±8.6
腹腔镜组	18.6±5.6	5.8±1.7	32.1±7.4
统计值	t=21.208	t=4.756	t=5.128
P值	<0.001	<0.001	<0.001

组别	例数	VAS(分)				F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
组别	例数	治疗前	术后1 d	术后3 d	术后7 d	F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
内镜组	110	5.2±1.5	3.0±0.9	1.6±0.5	0.9±0.3	156.822/89.474/28.366	<0.001/<0.001/<0.001
腹腔镜组	110	5.2±1.5	4.8±1.2	3.0±1.0	1.4±0.4	156.822/89.474/28.366	<0.001/<0.001/<0.001
t值		0.395	12.483	12.952	9.915
P值		0.693	<0.001	<0.001	<0.001
组别		AMS(U/L)				F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
组别		治疗前	术后1 d	术后3 d	术后7 d	F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
内镜组		42.4±10.3	285.6±45.4	98.5±22.6	62.4±15.4	98.564/112.345/52.180	<0.001/<0.001/<0.001
腹腔镜组		42.0±11.3	68.6±12.6	62.5±12.3	58.3±11.7	98.564/112.345/52.180	<0.001/<0.001/<0.001
t值		0.254	48.374	14.667	2.222
P值		0.800	<0.001	<0.001	0.027
组别		WBC(×10⁹/L)				F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
组别		治疗前	术后1 d	术后3 d	术后7 d	F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
内镜组		5.9±1.1	9.8±2.3	7.6±1.8	6.2±1.2	42.151/3.823/1.674	<0.001/0.052/0.174
腹腔镜组		5.9±1.2	10.6±2.3	8.2±2.1	6.5±1.5	42.151/3.823/1.674	<0.001/0.052/0.174
t值		0.441	2.456	2.487	1.596
P值		0.659	0.015	0.014	0.112
组别		CRP(mg/L)				F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
组别		治疗前	术后1 d	术后3 d	术后7 d	F_时间_/_组间_/_交互值	P_时间_/_组间_/_交互值
内镜组		3.2±1.1	15.6±3.5	8.5±2.6	3.3±1.0	86.231/78.563/32.452	<0.001/<0.001/<0.001
腹腔镜组		3.2±1.1	28.6±4.6	18.7±3.7	6.9±1.9	86.231/78.563/32.452	<0.001/<0.001/<0.001
t值		0.205	23.298	23.660	17.913
P值		0.838	<0.001	<0.001	<0.001

组别	例数	胆总管结石复发	反流性胆管炎	胆道狭窄	总发生
内镜组	110	18(16.4)	15(13.6)	5(4.6)	38(34.6)
腹腔镜组	110	8(7.3)	4(3.6)	3(2.7)	15(13.6)
χ²值		4.362	6.970	-	15.953
P值		0.037	0.008	0.723	<0.001

组别	例数	高淀粉酶血症	急性胰腺炎	消化道出血	十二指肠穿孔
内镜组	110	20(18.2)	8(7.3)	4(3.6)	1(0.9)
腹腔镜组	110	5(4.6)	1(0.9)	0	0
χ²值		10.154	-	-	-
P值		0.001	0.017	0.059	1.000
组别	胆道感染	腹腔出血	胆瘘	胆管狭窄	总发生
内镜组	6(5.5)	0	0	2(1.8)	41(37.3)
腹腔镜组	3(2.7)	2(1.8)	5(4.6)	1(0.9)	17(15.5)
χ²值	-	-	-	-	13.487
P值	0.307	0.497	0.024	1.000	<0.001

变量	回归系数	HR	95%置信区间	P值
模型1
内镜组	0.856	2.354	1.352~4.098	0.003
腹腔镜组	0.000	1.000	-	-
模型2
内镜组	0.825	2.282	1.298~4.012	0.004
腹腔镜组	0.000	1.000	-	-
模型3
内镜组	0.792	2.208	1.245~3.915	0.006
腹腔镜组	0.000	1.000	-	-

亚组	内镜组		腹腔镜组
亚组	事件数	例数	事件数	例数
年龄
<60岁	20	64	5	60
≥60岁	18	46	10	50
结石数量
单发	16	64	7	62
多发	22	46	8	48
最大结石最大径
<10 mm	12	68	8	60
≥10 mm	26	42	7	50
亚组	HR (95%置信区间)	P值	交互P值
年龄
<60岁	2.415(1.258~4.637)	0.008	0.071
≥60岁	1.623(0.862~3.056)	0.132	0.071
结石数量
单发	1.526(0.917~2.538)	0.104	0.032
多发	2.673(1.349~5.296)	0.005	0.032
最大结石最大径
<10 mm	1.384(0.825~2.323)	0.218	0.028
≥10 mm	2.589(1.286~5.210)	0.008	0.028

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