腹腔镜联合十二指肠镜与胆总管一期缝合治疗胆囊合并胆总管结石的疗效比较
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1.天津医科大学;2.天津市南开医院

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Comparison of duodenoscopy followed by laparoscopy and primary suture of common bile duct in treatment of cholecystolithiasis combined with choledocholithiasis
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Tianjin Medical University

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    摘要:

    目的比较经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),与腹腔镜胆总管探查Ⅰ期缝合(laparoscopic common bile duct exploration and primary suture,LBEPS)联合LC,治疗胆囊合并胆总管结石的临床疗效。方法采用回顾性病例对照研究方法,收集2018年1月—12月天津市南开医院收治的161例胆囊合并胆总管结石患者的临床资料,依据治疗方式不同分为ERCP+LC组(101例)和LC+LBEPS组(60例)。比较两组患者的结石清除率、手术相关并发症、住院时间、住院费用、术后结石残余率及术后生活质量。结果ERCP+LC组与LC+LBEPS组结石清除率[99.01%(100/101)比98.31%(59/60)]、手术相关并发症发生率[5.94%(6/101)比6.67%(4/60)]比较,差异均无统计学意义(P均>0.05)。ERCP+LC组住院时间长于LC+LBEPS组[15.00(13.00,19.00)d比11.00(9.50,13.00)d,P<0.001],住院费用高于LC+LBEPS组[57 655.00(51 237.47,63 674.32)元比33 904.18(28 201.96,41 785.93)元,P<0.001]。两组结石残余率比较差异有统计学意义[16.83%(17/101)比 0(0/60),P=0.001]。两组患者跟踪随访3~12个月,无远期并发症发生,生活质量评分差异均无统计学意义(P>0.05)。结论ERCP+LC与LC+LBEPS治疗胆囊合并胆总管结石均安全有效。根据病情,合理选择治疗方法,才能使患者最大受益。

    Abstract:

    ObjectiveTo compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) and LC plus laparoscopic common bile duct exploration and primary suture (LBEPS) in treatment of cholecystolithiasis combined with choledocholithiasis. MethodsThe clinical data of 161 patients of concomitant cholecystolithiasis and choledocholithiasis treated in Tianjin Nankai Hospital from January 2018 to December 2018 were retrospectively analyzed. Of the patients, 101 cases received ERCP followed by LC (ERCP+LC group), and 60 cases received LC plus LBEPS (LC+LBEPS group). The stone clearance rate, complications related to the operation, length of hospital stay, hospitalization expenses, postoperative residual stone rate and postoperative quality of life were compared between the two groups. ResultsThe ERCP+LC group and LC+LBEPS group had no statistical difference in the stone clearance rate [99.01% (100/101) VS 98.31% (59/60), P>0.05] and surgery related complications [5.94% (6/101) VS 6.67% (4/60), P>0.05]. The length of hospital stay of the ERCP+LC group was significantly longer than that of the LC+LBEPS group [15.00 (13.00, 19.00) days VS 11.00 (9.50, 13.00) days, P<0.001], and the same of hospitalization cost [57 655.00 (51 237.47, 63 674.32) yuan VS 33 904.18 (28 201.96, 41 785.93) yuan, P<0.001]. The residual stone rate showed significant difference between the ERCP+LC group and LC+LBEPS group [16.83% (17/101) VS 0 (0/60), P=0.001]. Both groups were followed up for 3 to 12 months. No long-term complications occurred, and three were no significant differences in the quality of life scores between the two groups (P>0.05). ConclusionERCP followed by LC and LC plus LBEPS are both safe and effective to treatment of cholecystolithiasis combined with choledocholithiasis. The clinicians should select the appropriate method in accordance with the actual condition of the patients.

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裴赛丽,王震宇.腹腔镜联合十二指肠镜与胆总管一期缝合治疗胆囊合并胆总管结石的疗效比较[J].中华消化内镜杂志,2020,37(6):435-440.

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  • 收稿日期:2019-05-22
  • 最后修改日期:2020-04-14
  • 录用日期:2019-07-22
  • 在线发布日期: 2020-06-28
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