摘要
目的比较腹腔镜胆囊切除术(LC)+腹腔镜胆总管切开胆道镜探查取石术(LCBDE)+胆总管一期缝合术与内镜逆行胰胆管造影(ERCP)+内镜下十二指肠括约肌切开取石术(EST)+鼻胆管引流术(ENBD)+LC治疗胆总管结石合并胆囊结石的临床疗效。方法收集2015年6月至2021年2月间山西白求恩医院普通外科收治的200例胆总管结石合并胆囊结石患者的临床资料, 根据治疗方式不同将患者分为行LC+LCBDE+胆总管一期缝合术(一期缝合组, 130例)和行ERCP+EST+ENBD+LC术(内镜手术组, 70例), 比较两组患者术中出血量, 手术时间, 术后进食时间, 术后胰腺炎、胆管炎及其他并发症(胆漏、腹腔出血、切口感染)发生率, 术后住院时间, 住院费用等。结果一期缝合组患者的术后胰腺炎发生率(0.7%比5.7%)、住院费用[(2.74±0.39)万元比(3.86±0.63)万元]均显著低于内镜手术组, 但手术时间[(103.21±9.36)min比(88.18±7.20)min]显著长于内镜手术组, 术后进食时间[(3.3±0.3)d比(2.2±0.8)d]迟于内镜手术组, 差异均有统计学意义(P值均<0.05);而术中出血量[(36.0±3.0)ml比(37.3±2.7)ml]、术后胆管炎发生率(1.5%比2.9%)、其他并发症发生率[胆漏(2.3%比1.4%)、腹腔出血(1.5%比4.3%)、切口感染(0比0)]、术后住院时间[(6.8±1.3)d比(7.1±1.7)d]与内镜手术组差异无统计学意义。结论两种微创术治疗胆总管结石合并胆囊结石疗效均较好, 但LC+LCBDE+胆总管一期缝合术保留了Oddis括约肌的功能, 维持胆总管正常解剖结构和生理功能, 降低了相关并发症的发生率, 有助于患者的恢复, 具有较高的安全性、有效性和可行性。
Objective To compare the clinical effectiveness of laparoscopic cholecystectomy(LC)+laparoscopic choledocholithotomy(LCBDE)+one-stage suture and primary choledocholithotomy with endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic duodenal sphincterotomy(EST)+nasobiliary drainage(ENBD)+LC in the treatment of choledocholithiasis complicated with gallbladder stones.Methods A total of 200 patients with choledocholithiasis complicated with gallbladder stones admitted to the General Surgery Department of Shanxi Bethune Hospital from June 2015 to February 2021 were collected,and patients were divided into LC+LCBDE+one-stage suture(one-stage suture group,n=130)and ERCP+EST+ENBD+LC(endoscopic surgery group,n=70)according to different treatments.The amount of intraoperative blood loss,operation time,postoperative feeding time,postoperative incidence of pancreatitis,cholangitis and other complications(biliary leakage,abdominal bleeding,wound infection),hospitalization costs,postoperative hospital stay,etc were compared between two groups.Results The postoperative incidence of pancreatitis in the one-stage suture group(0.7%vs 5.7%)and the hospitalization cost[(2.74±0.39)ten thousand yuan vs(3.86±0.63)ten thousand yuan]were significantly lower than those in the endoscopic surgery group.The operation time[(103.21±9.36)min vs(88.18±7.20)min]was significantly longer than that of the endoscopic surgery group,and postoperative feeding time[(3.3±0.3)d vs(2.2±0.8)d]were significantly later than the endoscopic surgery group(P<0.05).The amount of intraoperative blood loss[(36.0±3.0)ml vs(37.3±2.7)ml],the incidence of postoperative cholangitis(1.5%vs 2.9%)and other complications[biliary leakage(2.3%vs 1.4%),abdominal bleeding(1.5%vs 4.3%),wound infection(0 vs 0)],postoperative hospital stay[(6.8±1.3)d vs(7.1)d]had no significant differences between the two group.Conclusions The two minimally invasive methods for the treatment of choledocholithiasis complicated with gallbladder stones had good efficacy,but LC+LCBDE+
作者
刘世洲
贺杰峰
李燕军
Liu Shizhou;He Jiefeng;Li Yanjun(Department of General Surgery,Shanxi Bethune Hospital,Taiyuan 030000,China)
出处
《中华胰腺病杂志》
CAS
2022年第1期61-65,共5页
Chinese Journal of Pancreatology
