不同手术方案在复杂胆总管结石患者中的效果研究*

Comparison of different kinds of operation mode in treatment of complex common bile duct stones*

摘要:

目的  探讨内窥镜括约肌切开术（EST）或内镜逆行胰胆管造影术（ERCP）和腹腔镜胆总管探查术（LCBDE）联合腹腔镜胆囊切除术（LC）治疗胆囊结石合并胆总管结石的临床治疗效果。方法  选取2013年6月-2015年6月该院收治的复杂胆总管结石患者80例为研究对象，根据患者采取的手术方案，将患者分为EST+LC组（38例）和LCBDE+LC+ERCP组（42例）。比较两组患者的一般临床资料、治疗效果、术后并发症发生率及肝功能相关指标情况。结果  LCBDE+LC+ERCP组结石最大直径、胆总管直径均大于EST+LC组，其结石数量明显多于EST+LC组，差异均有统计学意义（P <0.05）。与EST+LC组相比，ERCP+LC+LCBDE组单次手术成功率较高，手术时间短，但其手术费用亦较高，差异均有统计学意义（P <0.05）；取石成功率、中转开腹率及住院时间在两组间差异无统计学意义（P >0.05）。ERCP+LC+LCBDE组术后并发症发生率为21.43%（9/42），EST+LC组术后并发症发生率为26.32%（10/38），两组间差异无统计学意义（P >0.05）。两组患者术后1 d的血清直接胆红素、丙氨酸转氨酶及天冬氨酸转氨酶均轻度升高，术后3 d两组患者各指标均恢复正常水平。结论  LCBDE+LC+ERCP以及EST+LC两种手术方案均是治疗复杂胆总管结石的有效方法，其中LCBDE+LC+ERCP手术成功率高，手术时间较短，对较大的结石更有优势。

Abstract:

Objective To investigate the clinical effects of endoscopic sphincterotomy (EST) or endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic treatment of gallbladder and common bile duct stones. Methods 80 patients suffered cholecystolithiasis with choledocholithiasis were selected from June 2013 to June 2015. According to surgical method, patients were divided into EST + LC group (38 cases) and LCBDE + LC + ERCP group (42 cases). Clinical data, treatment effects, postoperative complications rate related indicators of liver function were compared between the two groups. Results The maximum diameter of stones, diameter of common bile duct and the number of stones in LCBDE + LC + ERCP group were significantly longer and larger than EST + LC group, the differences were statistically significant (P < 0.05). Compared with EST + LC group, single success rate of ERCP + LC + LCBDE group was higher, operative time was shorter, but its operation cost was higher, the differences were statistically significant (P < 0.05). The success rate, rate of conversion to laparotomy and hospital stay between the two groups showed no significant difference (P > 0.05). Postoperative complication rate of ERCP + LC + LCBDE was 21.42 % (9/42), and postoperative complication rate of EST + LC was 26.32 % (9/42), the difference between the two groups were not clear (P > 0.05). The serum direct bilirubin, alanine aminotransferase and aspartate aminotransferase in the two groups were increased slightly after one day of operation, and those indexes returned to normal levels after three days of operation. Conclusion The operation methods of LCBDE + LC + ERCP and EST + LC are both effective treatment for complicated choledocholithiasis. The success rate of LCBDE + LC + ERCP is higher, the operative time is shorter, which is good for larger stones.