ERCP+LC and LC+LCBDE in the treatment of common bile duct stones with gallstone:aprospective randomized controlled study
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摘要: 目的:探讨腹腔镜胆囊切除(LC)联合胆总管探查取石术(LCBDE)和十二指肠镜逆行胰胆管造影术(ERCP)联合LC治疗胆管结石伴胆囊结石的临床疗效。方法:选取2011-08-2015-12期间在我院分别采用ERCP+LC(ERCP+LC组,n=69)与LC+LCBDE(LC+LCBDE组,n=76)治疗的胆总管结石伴胆囊结石患者,比较分析2组患者的疗效。结果:LC+LCBDE组患者的手术时间明显长于ERCP+LC组,手术次数和术后住院时间明显小于ERCP+LC组,差异均有统计学意义(P<0.05)。LC+LCBDE组的手术中转率、并发症发生率、结石残留率、术后下床活动时间均优于ERCP+LC组,差异无统计学意义。LC+LCBDE组患者的总体满意程度分布情况优于ERCP+LC组患者,差异具有统计学意义(P<0.05)。LC+LCBDE组复杂性胆总管结石患者取石成功率、术后住院时间、手术中转率、手术次数均明显优于ERCP+LC组复杂性胆总管结石患者,差异均有统计学意义(P<0.05)。结论:LC+LCBDE 与ERCP+LC治疗胆囊结石合并胆总管结石同样安全、有效。但LC+LCBDE住院时间更短,治疗费用更低,治疗胆总管结石数目多(≥3个)或结石直径较大(≥15 mm)或患有Mirizzi综合征的患者更有优势。Abstract: Objective:To investigate the clinical effect of laparoscopic cholecystectomy combined with common bile duct exploration and retrograde pancreatic duct radiography combined with LC in the treatment of cholecystolithiasis and choledocholithi.Method:The patients with common bile duct stones and gallbladder stones from August 2011 to October 2014 were treated by ERCP+LC (ERCP+LC group,n=69) and LC+LCBDE (LC+LCBDE group,n=76),the curative effect of two groups of patients were compared and analyzed.Result:The operation time of LC+LCBDE group was significantly longer than that of ERCP+LC group,the number of operation and postoperative hospital stay were significantly less than ERCP+LC group,the difference was statistically significant (P<0.05).In the LC+LCBDE group,the rate of surgery,the incidence of complications,residual stone rate,postoperative bed time were better than those of the ERCP+LC group,the difference was not statistically significant.The distribution of overall satisfaction degree of patients in LC+LCBDE group was better than that of ERCP+LC group,and the difference was statistically significant (P<0.05).Success rate,postoperative hospital stay,surgical conversion rate,number of operation of patients with complexity stones and common bile duct stones in LC+LCBDE group were significantly better than those of patients with complexity stones and common bile duct stones in ERCP+LC group,the differences were statistically significant (P<0.05).Conclusion:LC+LCBDE and ERCP+LC treatment of common bile duct stones and gallbladder stones is safe and effective.But LC+LCBDE can shorten hospital stay,reduce cost of treatment.The treatment of LC+LCBDE for patients with more bile duct stones (≥3) or with larger diameter if the calculi (≥15 mm) or with Mirizzi syndrome has more advantages.
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