Wang Xiaohong, Dai Chenguang, Jiang Zhonghua, Zhao Lili, Wang Min, Ma Limei, Tan Xueming, Liu Li, Wang Xiang, Fan Zhining
Department of Digestive Endoscopy and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China.
Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, China.
Oncotarget. 2017 Jun 27;8(47):82114-82122. doi: 10.18632/oncotarget.18839. eCollection 2017 Oct 10.
Common bile duct (CBD) stones are common in patients even after cholecystectomy. Besides endoscopic retrograde cholangiography (ERCP), laparoscopic common bile duct exploration (LCBDE) is also applied. This study aims to compare clinical indications, therapeutic benefits and complications for these two managements.
From October 2012 to February 2015, 1072 consecutive patients were diagnosed as choledocholithiasis in our single hospital. Post-cholecystectomy patients who underwent ERCP or LCBDE were included. Clinical data were analyzed, such as success rate, complications, procedure duration, postoperative hospital stay, total cost and recurrence of ductal stones. Prior ERCP, previous biliary anatomic alteration surgeries and lost to follow up were the excluding criteria.
141 patients were included according to the criteria, and 87 cases underwent ERCP and 54 cases underwent LCBDE. Age and sex distribution of patients were comparable between the two groups. The success rate for CBD stones clearance was 97.7% in the ERCP group, compared with 87.0% in the LCBDE group (=0.03). The mean procedure duration was also significantly shorter in ERCP group (52.0±15.8 vs. 102.9±40.1 min; <0.001). Postoperative hospital stay was similar (5.5±2.6 vs. 5.9±2.3 days; =0.40). And no significant difference for postoperative complications (3.4% vs. 11.1%; =0.15), total cost ($3787.1±1061.5 vs. $3983.54±1257.1, =0.32), and the rate of bile duct stones recurrence (6.9% vs. 7.4%, =1.00).
For clearing CBD stones in patients after cholecystectomy, ERCP was more efficient and might be the first choice, while LCBDE might be beneficial for patients with large stones.
即使在胆囊切除术后，胆总管结石在患者中也较为常见。除了内镜逆行胰胆管造影术（ERCP）外，腹腔镜胆总管探查术（LCBDE）也被应用。本研究旨在比较这两种治疗方法的临床适应证、治疗益处及并发症。
2012年10月至2015年2月，在我院连续1072例患者被诊断为胆总管结石。纳入接受ERCP或LCBDE的胆囊切除术后患者。分析临床数据，如成功率、并发症、手术时间、术后住院时间、总费用及胆管结石复发情况。排除标准为既往ERCP、既往胆道解剖改变手术及失访。
根据标准纳入141例患者，87例行ERCP，54例行LCBDE。两组患者的年龄和性别分布具有可比性。ERCP组胆总管结石清除成功率为97.7%，而LCBDE组为87.0%（P=0.03）。ERCP组的平均手术时间也显著更短（52.0±15.8对102.9±40.1分钟；P<0.001）。术后住院时间相似（5.5±2.6对5.9±2.3天；P=0.40）。术后并发症（3.4%对11.1%；P=0.15）、总费用（3787.1±1061.5美元对3983.54±1257.1美元，P=0.32）及胆管结石复发率（6.9%对7.4%，P=1.00）无显著差异。
对于胆囊切除术后患者清除胆总管结石，ERCP更有效，可能是首选，而LCBDE可能对大结石患者有益。
