ERCP+LC and LC+LCBDE in the treatment of common bile duct stones with gallstone:aprospective randomized controlled study
-
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.
-
-
[1] CHEN C B,QIU Y D,GU Y Y,et al.A meta-analysis to compare LC+LCBDE with ERCP+LC for patients with concomitant gallstones and common bile duct stones[J].Chinese Journal of Hepatobiliary Surgery,2013,19(10):752-757.
[2] 刘万涛,吴振华,李常恩,等.两种不同微创术式治疗胆囊结石合并胆总管结石效果比较的系统评价[J].中国循证医学杂志,2011,11(11):1313-1320.
[3] 高云峰.两种微创术式治疗胆囊结石合并胆总管结石的临床研究[J].中国医药科学,2011,1(11):118-119.
[4] Lv S,Fang Z,Wang A,et al.One-Step LC and ERCP treatment of 40cases with cholelithiasis complicated with common bile duct stones[J].Hepatogastroenterology,2015,62(139):570-572.
[5] Koc B,Karahan S,Adas G,et al.Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis:aprospective randomized study[J].Am J Surg,2013,206(4):457-463.
[6] ElGeidie A A,EIShobary M M,Naeem Y M.Laparoscopic exploration versus intraoperative endoscopic sphincterotomy for common bile duct stones:aprospective randomized trial[J].Dig Surg,2011,28(5/6):424-431.
[7] 曹继华,周大琼,李媛媛,等.LC+LCBDE治疗胆囊结石合并胆总管结石疗效的Meta分析[J].国际病理科学与临床杂志,2014,34(2):157-166.
[8] Poulose B K,Speroff T,Holzman M D.Optimizing choledocho-lithiasis management:a cost-effectiveness analysis[J].Arch Surg,2007,142(1):43-49.
[9] 蔡杰,邬善敏,李蔚,等.LC+LCBDE与EST+LC治疗继发性胆总管结石疗效的Meta分析[J].武汉大学学报:医学版,2013,34(1):90-94.
[10] Topal B,Vromman K,Aerts R,et al.Hospital cost categories of one stage versus two-stage management of common bile duct stones[J].Surg Endosc,2010,24(2):413-416.
[11] Noble H,Tranter S.A randomized,clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis[J].J Laparoendosc Adv Surg Tech A,2009,19(6):713-720.
[12] Noble H,Whitley E,Norton S,et al.A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration[J].Surg Endosc,2011,25(1):130-139.
[13] Bansal V K,Misra M C,Rajan K,et al.Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones:a randomized controlled trial[J].Surg Endosc,2014,28(3):875-885.
[14] 游蓁,叶辉,熊先泽,等.LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石的梗阻性黄疸患者的临床对照研究[J].中国普外基础与临床杂志,2013,20(11):1268-1270.
[15] Lau J Y,Leow C K,Fung T M,et al.Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients[J].Gastroenterology,2006,130(1):96-103.
[16] 刘万涛,吴振华,李常恩,等.两种不同微创术式治疗胆囊结石合并胆总管结石效果比较的系统评价[J].中国循证医学杂志,2011,11(11):1313-1320.
-
计量
- 文章访问数: 310
- PDF下载数: 424
- 施引文献: 0
下载: