[胆囊胆总管结石三种手术方式的比较]
[Comparison of three surgical patterns for cholecysto-choledocholithiasis].
作者信息
Du J W, Jin J H, Hu W X, Wang Z X, Zhao H P
机构信息
Department of Hepatobiliary Pancreato-Spleenic Surgery A, the Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010050, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2017 Jan 24;97(4):276-279. doi: 10.3760/cma.j.issn.0376-2491.2017.04.008.
To investigate the clinical efficiencies of the three surgical patterns in the treatment of cholecysto-choledocholithiasis (CCL). A total of 157 patients with CCL, during the period from Janury 2012 to Janury 2016 at the Affiliated Hospital of Inner Mongolia Medical University, were divided into three groups according to surgical patterns: LC-LCBDE Group (laparoscopic cholecystectomy+ laparoscopic common bile duct exploration, =49), ERCP-LC Group (endoscopic retrograde cholangiopancreatography+ laparoscopic cholecystectomy, =51) and OC-OCBDE Group (open cholecystectomy+ open common bile duct exploration, =57). Simultaneously, the intraoperative, postoperative and follow-up results of all the patients were compared. There were significantly differences among three groups in intraoperative blood loss[LC-LCBDE Group: (18.16±3.88) ml, ERCP-LC Group: (17.37±3.79) ml, and OC-OCBDE Group: (60.39±8.73) ml, =0.000], operation time[LC-LCBDE Group: (118.27±8.89) min, ERCP-LC Group: (124.27±9.48) min, and OC-OCBDE Group: (94.25±6.39) min, =0.000], surgical successful rate (LC-LCBDE Group 89.20%, ERCP-LC Group 86.93%, and OC-OCBDE Group 100%, =0.02), intestine function recovery[LC-LCBDE Group (42.35±3.44) h, ERCP-LC Group (43.61±3.34) h, and OC-OCBDE Group (53.86±4.76) h, =0.000], hospitalization cost[LC-LCBDE Group (18 600±1 300) yuan, ERCP-LC Group (33 300±2 000) yuan, and OC-OCBDE Group (13 800±1 900) yuan, =0.000], serum amylase elevation (LC-LCBDE Group 1 case, ERCP-LC Group 14 cases, and OC-OCBDE Group 2 cases, <0.01) and postoperative hospital stay (LC-LCBDE Group 5.20±0.77 d, ERCP-LC Group 4.85±0.51 d, and OC-OCBDE Group 8.55±0.71 d, =0.000). There were no differences among three groups in postoperative biliary leakage (LC-LCBDE Group 2 cases, ERCP-LC Group 0 case, and OC-OCBDE Group 2 cases) and residual bile duct stone rate (LC-LCBDE Group 4.08%, ERCP-LC Group 5.88%, and OC-OCBDE Group 3.50%). All three types of surgical pattern are both efficacious and safe in the treatment of CCL. But no single pattern has absolute advantage over the other two. LC-LCBDE could preserve the function of Oddis sphincter, ERCP-LC could retain the integrity of common bile duct (CBD), and OC-OCBDE could serve as remedial measure for LC-LCBDE and ERCP-LC.
探讨三种手术方式治疗胆囊胆总管结石（CCL）的临床疗效。选取2012年1月至2016年1月内蒙古医科大学附属医院收治的157例CCL患者，根据手术方式分为三组：LC-LCBDE组（腹腔镜胆囊切除术+腹腔镜胆总管探查术，n=49）、ERCP-LC组（内镜逆行胰胆管造影术+腹腔镜胆囊切除术，n=51）和OC-OCBDE组（开腹胆囊切除术+开腹胆总管探查术，n=57）。同时，比较所有患者的术中、术后及随访结果。三组患者在术中出血量[LC-LCBDE组：（18.16±3.88）ml，ERCP-LC组：（17.37±3.79）ml，OC-OCBDE组：（60.39±8.73）ml，P=0.000]、手术时间[LC-LCBDE组：（118.27±8.89）min，ERCP-LC组：（124.27±9.48）min，OC-OCBDE组：（94.25±6.39）min，P=0.000]、手术成功率（LC-LCBDE组89.20%，ERCP-LC组86.93%，OC-OCBDE组100%，P=0.02）、肠功能恢复时间[LC-LCBDE组（42.35±3.44）h，ERCP-LC组（43.61±3.34）h，OC-OCBDE组（53.86±4.76）h，P=0.000]、住院费用[LC-LCBDE组（18 600±1 300）元，ERCP-LC组（33 300±2 000）元，OC-OCBDE组（13 800±1 900）元，P=0.000]、血清淀粉酶升高情况（LC-LCBDE组1例，ERCP-LC组14例，OC-OCBDE组2例，P<0.01）及术后住院时间[LC-LCBDE组5.20±0.77 d，ERCP-LC组4.85±0.51 d，OC-OCBDE组8.55±0.71 d，P=0.000]方面存在显著差异。三组患者在术后胆漏（LC-LCBDE组2例，ERCP-LC组0例，OC-OCBDE组2例）和残余胆管结石率（LC-LCBDE组4.08%，ERCP-LC组5.88%，OC-OCBDE组3.50%）方面无差异。三种手术方式治疗CCL均有效且安全。但没有一种手术方式相对于其他两种具有绝对优势。LC-LCBDE可保留Oddis括约肌功能，ERCP-LC可保持胆总管（CBD）的完整性，OC-OCBDE可作为LC-LCBDE和ERCP-LC的补救措施。
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