两种微创手术治疗胆囊结石合并胆总管结石的疗效比较

Efficacy comparison of two types of minimally invasive procedures for concomitant cholecystolithiasis and choledocholithiasis

摘要:

背景与目的 腹腔镜胆囊切除术+经胆囊管胆总管探查取石术（LC+LTCBDE）与内镜逆行胰胆管造影/十二指肠乳头括约肌切开取石术+腹腔镜胆囊切除术（ERCP/EST+LC）均是治疗胆囊结石合并胆总管结石的微创手段，但两者的疗效优劣仍有争议。本研究通过回顾性分析比较两种微创术式治疗胆囊结石合并胆总管结石的疗效。方法 回顾性分析2017年7月—2020年8月四川省内江市第二人民医院收治的161例胆囊结石合并胆总管结石患者的临床资料，其中78例行LC+LTCDBE，83例行ERCP/EST+LC。比较两组患者的手术成功率、结石残留率、手术时间、住院时间、住院费用、术后近远期并发症发生率及结石复发率。结果 两组手术成功率、结石残留率差异均无统计学意义（均P>0.05）。LC+LTCDBE组手术时间长于ERCP/EST+LC组（156.13 min vs. 129.39 min），住院时间短于ERCP/EST+LC组（8.17 d vs. 13.06 d），住院费用低于ERCP/EST+LC组（17 582.68元vs. 29 403.10元），差异均有统计学意义（均P<0.001）；LC+LTCDBE组近期胆汁漏的发生率更高（7.7% vs. 0，P=0.010），但胰腺炎的发生率更低（1.3% vs. 8.4%，P=0.037）；ERCP/EST+LC组远期胆管炎的发生率更高（1.3% vs. 8.4%，P=0.037）；两组结石复发率差异无统计学意义（P>0.05）。结论 LC+LTCBDE与ERCP/EST+LC均为治疗胆囊结石合并胆总管结石安全有效的手术方式，但LC+LTCBDE相对于ERCP/EST+LC住院时间更短，住院费用更低，术后远期并发症更少，故在同样适应证下，可优先选择。

Abstract:

Background and Aims Laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration (LC+LTCBDE) and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy combined with laparoscopic cholecystectomy (ERCP/EST+LC) both are minimally invasive procedures for the treatment of cholecystolithiasis with choledocholithiasis. However, the merits of the two procedures are still under debate. Therefore, this study was performed to compare the efficacy of the two minimally invasive procedures in the treatment of concomitant cholecystolithiasis and choledocholithiasis through a retrospective analysis.Methods The clinical data of 161 patients with concomitant cholecystolithiasis and choledocholithiasis whom been treated in the Second People's Hospital of Neijiang City from July 2017 to August 2020 were retrospectively analyzed. Of the patients, 78 cases underwent LC+LTCDBE, and 83 cases were subjected to ERCP/EST+LC. The operation success rate, residual stone rate, operative time, length of hospitalization, and incidence rates of postoperative short- and long-term complications were compared between the two groups.Results There was no significant difference in the operation success rate and residual stone rate between the two groups (both P>0.05). In LC+LTCDBE group versus ERCP/EST+LC group, the operative time was longer (156.13 min vs. 129.39 min), the length of hospitalization was shorter (8.17 d vs. 13.06 d), and the hospitalization cost was lower (17 582.68 yuan vs. 29 403.10 yuan), all the differences had a statistical significance (all P<0.001). The incidence rate short-term of bile leakage was higher (7.7% vs. 0, P=0.010), but the incidence rate of pancreatitis was lower in LC+LTCDBE group than those in ERCP/EST+LC group (1.3% vs. 8.4%, P=0.037); the incidence rate of long-term cholangitis was lower in LC+LTCDBE group than that in ERCP/EST+LC group (1.3% vs. 8.4%, P=0.037). No statistical difference was noted in stone recurrence rate between the two groups (P>0.05).Conclusion Both LC+LTCBDE and ERCP/EST+LC are safe and effective surgical approaches for concomitant cholecystolithiasis and choledocholithiasis. Moreover, LC+LTCBDE offers a shortened length of hospitalization, reduced hospitalization cost, and decreased long-term complications compared with ERCP/EST+LC. Thus, it can be regarded as the preferred choice under the same indications.