腹腔镜胆总管探查术与内镜十二指肠乳头括约肌切开术后胆总管结石复发率比较

Comparison of the recurrence rate of calculus of the common bile duct after laparoscopic common bile duct exploration and endoscopic sphincterotomy

摘要:

目的 评估腹腔镜胆总管探查术（LCBDE）与内镜十二指肠乳头括约肌切开术（EST）联合腹腔镜胆囊切除术（LC），治疗胆囊结石伴胆总管结石患者的远期疗效。方法 回顾性分析2018年1月－2020年12月该院272例符合特定标准的胆囊结石伴胆总管结石患者（胆总管直径为9～15 mm，结石最大径 < 15 mm）的临床资料，根据手术方式不同，将患者分为LCBDE+LC组和EST+LC组。重点比较两组患者胆总管结石复发情况。结果 术后随访数据显示，LCBDE+LC组术后结石复发率为12.0%，较EST+LC组的15.6%低，但两组比较，差异无统计学意义（P > 0.05）。结论 针对胆总管直径为9～15 mm的胆囊结石伴胆总管结石患者，LCBDE+LC与EST+LC两种术式均为安全、有效的治疗选择。临床决策时，建议结合患者个体特征进行综合评估，选取最适宜的手术方案。

Abstract:

Objective To evaluate the long-term efficacy differences between laparoscopic common bile duct exploration (LCBDE) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC) in treating patients with gallstones and calculus of the common bile duct.Methods A retrospective study was conducted involving 272 patients with gallstones accompanied by calculus of the common bile duct (common bile duct diameter ranging from 9 ~ 15 mm, with the largest stone diameter < 15 mm) who met specific criteria. The patients were systematically compared and analyzed based on surgical methods, divided into the LCBDE + LC group and the EST + LC group. Comparing the recurrence rates of calculus of the common bile duct.Results Postoperative follow-up data showed that the LCBDE + LC group exhibited a relatively lower trend in postoperative stone recurrence rate (12.0% vs. 15.6%), but statistical analysis revealed no significant difference between the groups (P > 0.05).Conclusion For patients with gallstones and calculus of the common bile duct with a common bile duct diameter of 9 ~ 15 mm, both LCBDE + LC and EST + LC are safe and effective treatment options. When making clinical decisions, it is recommended to conduct a comprehensive evaluation based on the individual characteristics of the patient and select the most suitable surgical plan.