Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, 225001, China.
Department of Hepatobiliary Surgery, The First Clinical College, Dalian Medical University, Dalian, 116027, Liaoning, China.
J Gastrointest Surg. 2023 Jun;27(6):1167-1176. doi: 10.1007/s11605-023-05645-5. Epub 2023 Mar 22.
The optimal treatment options for gallstones together with common bile duct stones (CBDS) remain controversial. The aim of this study was to further compare the recurrence rate of stones after synchronous laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (SLCL) and synchronous laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy (SLCE) and to determine which option is more effective in reducing the rate of repeated recurrence of CBDS and the incidence rate of hepatolithiasis.
We retrospectively investigated the clinical data of patients who underwent SLCL or SLCE at our hepatobiliary center between August 2012 and August 2020. The primary and secondary endpoints of this study were the recurrence of CBDS and the occurrence of hepatolithiasis, respectively.
In total, 1005 patients were enrolled in this study, including 431 patients in the SLCL group and 574 patients in the SLCE group. SLCL was associated with a significantly decreased rate of CBDS recurrence (4.18% vs. 7.84%, P = 0.018), repeated CBDS recurrence (0.70% vs. 3.00%, P = 0.010), and incidence of hepatolithiasis (0.00% vs. 1.05%, P = 0.040). Compared with SLCE, SLCL was an independent protective predictor of the recurrence of CBDS (relative risk, 0.505; 95% confidence interval, 0.286-0.891; P = 0.018) and repeated recurrence of CBDS (relative risk, 0.226; 95% confidence interval, 0.066-0.777; P = 0.018).
SLCL is an optimal treatment option to SLCE for patients with gallstones combined with CBDS.
胆结石合并胆总管结石（CBDS）的最佳治疗选择仍存在争议。本研究旨在进一步比较腹腔镜胆囊切除术联合腹腔镜胆总管探查术（SLCL）与腹腔镜胆囊切除术联合术中内镜括约肌切开术（SLCE）后结石复发率，并确定哪种选择更能有效降低 CBDS 再次复发率和肝胆管结石发生率。
我们回顾性调查了 2012 年 8 月至 2020 年 8 月期间在我院肝胆中心接受 SLCL 或 SLCE 的患者的临床资料。本研究的主要和次要终点分别为 CBDS 的复发和肝胆管结石的发生。
共有 1005 例患者纳入本研究，其中 SLCL 组 431 例，SLCE 组 574 例。SLCL 与 CBDS 复发率降低显著相关（4.18%比 7.84%，P=0.018）、重复 CBDS 复发（0.70%比 3.00%，P=0.010）和肝胆管结石发生率（0.00%比 1.05%，P=0.040）。与 SLCE 相比，SLCL 是 CBDS 复发（相对风险，0.505；95%置信区间，0.286-0.891；P=0.018）和重复复发的独立保护预测因子（相对风险，0.226；95%置信区间，0.066-0.777；P=0.018）。
对于胆结石合并 CBDS 的患者，SLCL 是 SLCE 的一种优选治疗选择。
