Li Shengyong, Li Yuliang, Geng Jianli, Liu Bin, Gao Ruohui, Zhou Zhongxiao, Hu Sanyuan
1 Department of General Surgery, Qilu Hospital, Shandong University , Jinan, People's Republic of China .
2 Department of Hepatobiliary Surgery, The Municipal Hospital of Weihai , Weihai, People's Republic of China .
J Laparoendosc Adv Surg Tech A. 2015 Nov;25(11):886-91. doi: 10.1089/lap.2015.0220.
To evaluate the clinical effectiveness and safety of percutaneous transhepatic papillary balloon dilatation (PPBD) combined with laparoscopic cholecystectomy (LC) for the treatment of gallstones with common bile duct stones.
From February 2012 to January 2013, 65 patients (31 males and 34 females) who had gallstones with common bile duct stones were divided into two groups: endoscopic papillary balloon dilatation (EPBD)+LC (n = 40 cases) and PPBD+LC (n = 25 cases). The maximum transverse diameter of common bile duct stoned was 15 mm. White blood cell count and serum amylase level were measured at 12 hours and 72 hours after the operation, and operation time, time of gastrointestinal function recovery, and hospitalization time were analyzed.
No case in either group was converted to open surgery. The stones were successfully pushed out into the duodenum in all patients of both groups. One case of postoperative pancreatitis (2.5%) and 5 cases of hyperamylasemia (12.5%) occurred among the 40 patients in the EPBD+LC group. In contrast, no case of postoperative pancreatitis and 2 cases of hyperamylasemia (8%) occurred among the 25 patients in the PPBD+LC group. The serum amylase level at 12 hours postoperatively was statistically significantly different (307 ± 39.94 IU/L in the EPBD+LC group and 193 ± 30.78 IU/L in the PPBD+LC group; P < .05). There were no significant differences between the two groups in operative time, postoperative gastrointestinal function recovery time, or hospital stay time (P > .05). During follow-up of 2 years, 1 case of recurrence for common bile duct stones was discovered and was treated successfully with EPBD repeatedly.
PPBD combined with LC simultaneously is an alternative effective and safe procedure for the treatment of gallstones and bile duct stones, especially for those patients who are unsuitable for endoscopic treatment.
评估经皮经肝乳头球囊扩张术（PPBD）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有效性和安全性。
2012年2月至2013年1月，65例胆囊结石合并胆总管结石患者（男31例，女34例）分为两组：内镜乳头球囊扩张术（EPBD）+LC组（n = 40例）和PPBD+LC组（n = 25例）。胆总管结石最大横径为15mm。术后12小时和72小时测量白细胞计数和血清淀粉酶水平，并分析手术时间、胃肠功能恢复时间和住院时间。
两组均无病例转为开腹手术。两组所有患者结石均成功排入十二指肠。EPBD+LC组40例患者中发生1例术后胰腺炎（2.5%）和5例高淀粉酶血症（12.5%）。相比之下，PPBD+LC组25例患者中未发生术后胰腺炎，发生2例高淀粉酶血症（8%）。术后12小时血清淀粉酶水平差异有统计学意义（EPBD+LC组为307±39.94IU/L，PPBD+LC组为193±30.78IU/L；P <.05）。两组手术时间、术后胃肠功能恢复时间或住院时间差异无统计学意义（P >.05）。随访2年期间，发现1例胆总管结石复发，经反复EPBD成功治疗。
PPBD联合LC同时进行是治疗胆囊结石和胆管结石的一种有效且安全的替代方法，尤其适用于那些不适合内镜治疗的患者。
