Liu Fuguo, Ye Lunhe, Wang Yongkun, Zhao Zinan, Mutailipu Muladili, Wang Xujing, Zhang Qiqi, Chen Bo, Cui Ran
Department of Hepatopancreatobiliary Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of ICU, GanZhou People's Hospital, Ganzhou, China.
J Laparoendosc Adv Surg Tech A. 2025 Feb;35(2):145-151. doi: 10.1089/lap.2024.0345. Epub 2024 Nov 12.
Minimally invasive treatments for cholelithiasis have gained popularity. The complexity of diagnosing and treating choledocholithiasis offers multiple surgical options, including laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography and/or endoscopic sphincterotomy plus laparoscopic cholecystectomy (ERCP/EST+LC). To compare outcomes in patients with typical signs, symptoms, laboratory, and imaging features of cholelithiasis combined with common bile duct stones, we retrospectively analyzed the short-term outcomes of LCBDE+LC and ERCP/EST+LC. We analyzed 318 patients with gallbladder stones treated between January 2022 and May 2024. Of these, 152 underwent LCBDE+LC, and 166 underwent ERCP/EST+LC. We compared patients' baseline characteristics, perioperative outcomes, and short-term complications between the two groups. The primary outcome was the effectiveness of choledochal stone removal, while secondary outcomes included length of stay, hospitalization costs, and patient satisfaction. Patients' baseline characteristics were similar between the LCBDE+LC and ERCP/EST+LC groups. Stone clearance rates were comparable (97.37% versus 95.18%, = .306), with a slight advantage in the LCBDE+LC group. The length of hospitalization was significantly shorter in the LCBDE+LC group (6.49 ± 1.18 days versus 6.77 ± 1.11 days, < .05). The LCBDE+LC group also had lower total hospitalization costs ($5188.78 ± 861.26 versus $6498.76 ± 1190.58 < .01). Additionally, the incidence of pancreatitis was lower in the LCBDE+LC group (0.66% versus 6.02%, < .01). There were no significant differences between the groups in other short-term complications such as abdominal infection, cholangitis, biliary bleeding, or bile leakage. Postoperative follow-up indicated higher patient satisfaction and acceptance in the LCBDE+LC group (SSQ-8, 85.84 ± 4.31 points versus 81.20 ± 4.54 points, < .01). Our findings suggest that the LCBDE+LC holds promise as a safe and efficacious approach for the management of cholelithiasis combined with common bile duct stones. However, further prospective clinical trials are essential to corroborate these results and confirm their broader applicability.
胆石症的微创治疗已越来越受欢迎。胆总管结石的诊断和治疗复杂性提供了多种手术选择，包括腹腔镜胆总管探查术加腹腔镜胆囊切除术（LCBDE+LC）以及内镜逆行胰胆管造影术和/或内镜括约肌切开术加腹腔镜胆囊切除术（ERCP/EST+LC）。为比较具有典型症状、体征、实验室检查和影像学特征的胆石症合并胆总管结石患者的治疗效果，我们回顾性分析了LCBDE+LC和ERCP/EST+LC的短期疗效。我们分析了2022年1月至2024年5月期间接受治疗的318例胆囊结石患者。其中，152例行LCBDE+LC，166例行ERCP/EST+LC。我们比较了两组患者的基线特征、围手术期结局和短期并发症。主要结局是胆总管结石清除的有效性，次要结局包括住院时间、住院费用和患者满意度。LCBDE+LC组和ERCP/EST+LC组患者的基线特征相似。结石清除率相当（97.37%对95.18%，P = 0.306），LCBDE+LC组略有优势。LCBDE+LC组的住院时间明显更短（6.49±1.18天对6.77±1.11天，P<0.05）。LCBDE+LC组的总住院费用也更低（5188.78±861.26美元对6498.76±1190.58美元，P<0.01）。此外，LCBDE+LC组胰腺炎的发生率更低（0.66%对6.02%，P<0.01）。两组在腹部感染、胆管炎、胆道出 血或胆漏等其他短期并发症方面无显著差异。术后随访显示LCBDE+LC组患者的满意度和接受度更高（SSQ-8，85.84±4.31分对81.20±4.54分，P<0.01）。我们的研究结果表明，LCBDE+LC有望成为治疗胆石症合并胆总管结石的一种安全有效的方法。然而，进一步的前瞻性临床试验对于证实这些结果并确认其更广泛的适用性至关重要。
