内镜逆行胰胆管造影术序贯腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的临床疗效分析

Clinical efficacy analysis of sequential endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy in treating cholecystolithiasis combined with calculus of common bile duct

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）序贯腹腔镜胆囊切除术（LC）与分期两镜手术治疗胆囊结石合并胆总管结石的可行性及安全性。方法 回顾性分析2023年1月－2024年10月多中心收治并确诊的683例胆囊结石合并胆总管结石患者的临床资料，包括：绍兴市上虞人民医院81例，山东省立第三医院224例和同济大学附属东方医院378例。按照治疗方法不同分为两组，A组（n = 346）同次住院期间序贯应用ERCP+LC，B组（n = 337）先行ERCP，6～8周后再行LC。比较两组患者围手术期指标、临床疗效、并发症发生率和胆囊粘连严重程度。结果 两组患者的ERCP手术时间、ERCP取石成功率、非计划再入院率和并发症发生率比较，差异均无统计学意义（P 0.05）；A组的LC时间、总手术时间和住院时间明显短于B组，差异均有统计学意义（P 0.05）；B组ERCP术后胆囊粘连为高粘连等级（3和4级）的占比明显高于A组，差异有统计学意义（P 0.05）。结论 同次住院ERCP序贯LC治疗胆囊结石合并胆总管结石安全、高效，与分期两镜手术相比，总手术时间和住院时间短，且不增加并发症发生率，ERCP术后胆囊粘连程度轻。值得临床推广应用。

Abstract:

Objective Comparative analysis of therapeutic feasibility and safety between sequential endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) and two-staged endoscopic procedures in managing cholecystolithiasis combined with calculus of common bile duct.Methods Multicenter retrospective data of 683 patients treated between January 2023 and October 2024 were enrolled, including 81 cases from Shangyu People’s Hospital, 224 from Shandong Provincial Third Hospital, and 378 from Shanghai East Hospital. Patients were divided into two groups: group A (n = 346, same-hospital sequential ERCP + LC) and group B (n = 337, staged ERCP and LC after 6 ~ 8 weeks). Perioperative parameters, clinical efficacy, complication rates, and gallbladder adhesion grades were compared.Results No significant intergroup differences were found in ERCP operation time, stone clearance success rate, unplanned readmission rate, or total complication incidence (P 0.05). Group A exhibited shorter LC duration, total combined operative time, and length of hospital stay (P 0.05). The proportion of severe gallbladder adhesions (grades 3 and 4) was significantly higher in the group B (P 0.05).Conclusion Same-hospital sequential ERCP followed by LC is safe and efficient for cholecystolithiasis combined with calculus of common bile duct. Compared with two-staged endoscopic procedures, this strategy shortens total operative and hospital stay without elevating complication risks and reduces severe postoperative gallbladder adhesions, which deserves widespread clinical promotion.