腹腔镜胆总管取石和内镜乳头切开取石治疗胆总管结石的回顾性分析

目的:分析两种微创手术方式:腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)结合胆总管取石术(laparoscopic common bile duct extraction,LCBDE)和内镜下乳头括约肌切开(endoscopic sphincterotomy,EST)取石联合LC治疗胆囊结石合并胆总管结石病人的疗效和安全性。方法:回顾近4年余胆囊结石合并胆总管结石病人的临床资料,其中LC+LCBDE组40例,EST+LC组40例。比较两组手术成功率、结石清除率以及术后并发症发生率等指标。结果:LC+LCBDE组与EST+LC组手术成功率(97.5%比95.0%)、结石清除率(90.0%比92.5%)、术后近期并发症发生率(7.5%比5.0%)比较,差异无统计学意义(P>0.05)。两组都无围手术期死亡。LC+LCBDE组住院费用与住院时间低于EST+LC组(P<0.001)。LC+LCBDE组未发生远期并发症、无结石复发、EST+LC组2例结石复发和4例发生远期并发症(3例胆道感染、1例复发性胰腺炎)(15.0%)。结论:本研究显示,LC+LCBDE与EST+LC治疗胆囊结石合并胆总管结石的疗效及安全性相似。LC+LCBDE治疗既保留了Oddi括约肌的功能,避免EST相关的潜在风险;同时缩短住院时间,降低住院费用。

Retrospective analysis of laparoscopic common bile duct extraction vs endoscopic sphincterotomy in patients with choledocholithiasis

Objective To evaluate the efficacy and safety of laparoscopic cholecystectomy plus laparoscopic common bile duct extraction （LC＋LCBDE） and endoscopic sphincterotomy plus LC （EST＋LC） in treatment of the patients with concomitant common bile duct stones and gallstones. Methods The clinical data of patients with gallstones and common bile duct stones were analyzed retrospectively in our hospital including 40 cases in LC ＋LCBDE group and 40 cases in EST＋LC group between Jan 2009 and Jun 2013. The indexes in the two groups including operation success rate, stone clearance rate, morbidity were compared. Results There was no statistically significant difference in the operation success rate （97.5% for LC＋LCBDE vs 95.0% for EST＋LC）, stone clearance rate （90.0% vs 92.5%）, and short-form postoperative complication （7.5% vs 5.0% ） （P〉0.05）. There was no perioperative mortality of both groups. LC＋LCBDE group had lower costs, shorter hospital stay than EST＋LC group （P〈0.001）. No long-term complication and recurrence of stones was found in LC ＋LCBDE group. However, common bile duct stones recurred in 2 cases and long-term complications including 3 cases with biliary infection and 1 case with pancreatitis were found in EST＋LC group （15%）. Conclusions Both LC＋LCBDE and EST＋LC are highly effective in treating gallstones and concomitant common bile duct stones and have patients safety. LC ＋LCBDE maintain the integrity of sphincter of Oddi and avoid EST-associated complication. The duration of hospitalization is shorter and hospital fee charge lower for LC＋LCBDE.