胆总管结石合并胆囊结石患者内镜逆行胰胆管造影术后行腹腔镜胆囊切除术的时机研究

Study on the timing of laparoscopic cholecystectomy operation in patients with calculus of common bile duct combined with cholecystolithiasis after endoscopic retrograde cholangiopancreatography

摘要:

目的 探讨胆总管结石合并胆囊结石患者内镜逆行胰胆管造影术（ERCP）后行腹腔镜胆囊切除术（LC）的时机。方法 回顾性分析该院2015年6月－2023年5月258例接受ERCP联合LC治疗胆总管结石合并胆囊结石的患者的临床资料。按照ERCP与LC间期不同分为：A组（≤24 h）、B组（24～72 h）和C组（ > 72 h）。结果 C组LC手术时间为58.0（46.0，73.0）min，明显长于A组的43.5（35.3，51.0）min和B组的43.0（35.0，51.0）min；C组腹腔引流管留置率为31.3%（21/67），明显高于A组的8.9%和B组的8.1%；B组行四孔法LC的3例（2.2%），明显少于A组的7例（12.5%）和C组的9例（13.4%），C组住院总时间长于A组和B组，差异均有统计学意义（P < 0.05）。3组患者术后并发症总发生率、再次ERCP率、LC术后住院时间和住院费用比较，差异均无统计学意义（P > 0.05）。结论 ERCP术后24～72 h行LC是胆总管结石合并胆囊结石患者安全、有效、易行和经济的治疗时机。

Abstract:

Objective To investigate the timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculus of common bile duct complicated by choledocholithiasis.Methods Retrospective analysis was performed on patients with calculus of common bile duct complicated by cholecystolithiasis treated with ERCP combined with LC from June 2015 to May 2023. All the eligible 258 patients were divided into group A (≤ 4 h), group B (24 ~ 72 h), and group C ( > 72 h) according to different ERCP-LC intervals.Results LC operation time in group C was 58.0 (46.0, 73.0) min, which was significantly longer than that in group A [43.5 (35.3, 51.0)] min and group B [43.0 (35.0, 51.0)] min; The rate of intraabdominal drainage tube in group C was 31.3% (21/67), which was significantly higher than that in group A (8.9%) and group B (8.1%); There were 3 cases (2.2%) of four-hole LC in group B, significantly less than 7 cases (12.5%) in group A and 9 cases (13.4%) in group C; The total hospitalization time in group C was significantly longer than that in group A and group B, with statistical significance (P < 0.05). There was no significant difference in incidence of postoperative complications, repeated ERCP rate, length of stay after LC and hospitalization cost among the three groups (P > 0.05).Conclusion LC within 24~72 h after ERCP operation is a safe, effective, feasible and economical treatment opportunity for patients with calculus of common bile duct combined with cholecystolithiasis.