LC联合ERCP一期治疗胆囊结石合并肝外胆管结石与分期ERCP+LC手术疗效比较

摘要/Abstract

摘要：

目的：探讨比较腹腔镜胆囊切除术（laparoscopic cholecystectomy, LC）联合内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）一期治疗胆囊结石合并肝外胆管结石与分期手术的临床疗效。方法：本院2018年4月至2020年4月期间收治的191例胆囊结石合并肝外胆管结石的病人分为两组,98例行LC联合一期ERCP取石（研究组）;93例行ERCP取石+择期LC（对照组）。比较两组的手术时间、术中出血量、术后住院时间、手术成功率、并发症发生以及住院费用。结果：与对照组相比,研究组手术时间、术后住院时间、住院费用均明显降低（P<0.05）,术中出血量、手术成功率和术后并发症发生率差异无统计学意义（P>0.05）。结论：LC联合ERCP取石一期治疗胆囊结石合并肝外胆管结石安全可行,具有手术时间短、术后住院时间短、住院费用低的优点。

关键词:胆囊结石,肝外胆管结石,腹腔镜胆囊切除术,内镜逆行胰胆管造影

Abstract:ObjectiveTo explore the clinical effect of laparoscopic cholecystectomy(LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) in treatment of cholecystolithiasis combined with choledolithiasis in one stage approach compared with two stage procedure.MethodsA total of 191 patients with cholecystolithiasis and choledocholithiasis admitted to our hospital from April 2018 to April 2020 were divided into two groups. Ninty-eight patients were treated with LC and ERCP in one stage approach (study group) and 93 patients in two stage procedure(control group). Operative time, bleeding loss, postoperative length of hospital stay, success rate, complication and hospital cost were compared between two groups.ResultsCompared with two stage procedure in control group, operative time, postoperative length of hospital stay and hospital cost (P<0.05) reduced significantly in one stage approach(study group), and there was no significant difference between two groups in bleeding loss, success rate, and postoperative complications (P>0.05).ConclusionsLC with ERCP in one stage approach would be safe and feasible for the patients of cholecystolithiasis and choledolithiasis with advantages of short both operative time and hospital stay and low cost.

Key words:Cholecystolithiasis,Choledocholithiasis,Laparoscopic cholecystectomy,Endoscopic retrograde cholangiopancreatography

中图分类号:

R657.42

胡刚峰, 黄侠. LC联合ERCP一期治疗胆囊结石合并肝外胆管结石与分期ERCP+LC手术疗效比较[J]. 外科理论与实践, 2021, 26(05): 437-440.

HU Gangfeng, HUANG Xia. Comparison of surgical efficiency of laparoscopic cholecystectomy and ERCP in treatment of cholecystolithiasis and choledocholithiasis between one stage approach and two stage procedure[J]. Journal of Surgery Concepts & Practice, 2021, 26(05): 437-440.

图/表3

项目	研究组（n=98）	对照组（n=93）	P值
年龄（岁）	49.5±15.8	50.3±13.6	>0.05
男/女	45/53	43/50	>0.05
高血压	43（43.8）	39（41.9）	>0.05
糖尿病	34（34.6）	29（31.1）	>0.05
上腹痛	98（100）	93（100）	>0.05
黄疸	69（70.4）	62（66.6）	>0.05
丙氨酸转氨酶（U/L）	126.3±20.2	121.2±16.6	>0.05
肝外胆管结石数量（枚）	2.3±0.7	2.4±0.5	>0.05

表1

项目	研究组（n=98）	对照组（n=93）	P值
手术时间（min）	73.3±16.5	85.1±15.3	<0.05
术中出血量（mL）	42.9±4.8	45.7±5.4	>0.05
术后住院时间（d）	5.2±1.1	11.3±2.8	<0.05
住院费用（人民币：元）	24 648.2±985.2	32 417.2±987.6	<0.05

表2

项目	研究组（n=98）	对照组（n=93）	P值
总并发症	5（5.10）	5（5.38）	>0.05
急性轻型胰腺炎	2	3
胆漏	1	1
十二指肠乳头出血	1	1
胆道感染	1	0

表3

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