Liao Jia-Hua, Li Ju-Shi, Wang Tie-Long, Liu Wen-Shen
Department of Hepatobiliary Surgery, Shaoyang Central Hospital, Shaoyang 422000, Hunan Province, China.
Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
World J Gastrointest Surg. 2024 Nov 27;16(11):3511-3519. doi: 10.4240/wjgs.v16.i11.3511.
There remain controversies regarding the surgical treatment of extrahepatic bile duct stones (EHBDSs) in clinical practice.
To explore the curative effect of laparoscopic cholecystectomy (LC) plus common bile duct exploration (CBDE) for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone recurrence.
Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were selected. Among them, patients treated with open choledocholithotomy plus LC or open cholecystectomy (OC) were set as the control group ( = 40), and those treated with LC plus CBDE served as the observation group ( = 42). The surgical outcomes of the two groups were compared, the surgical complications and Gastrointestinal Quality of Life Index (GIQLI) scores were counted, and the one-year prognostic recurrence was recorded. Independent factors for postoperative recurrence were determined using univariate and multivariate analyses.
The two groups were comparable in the stone residual rate ( > 0.05). The operation time ( < 0.05), intraoperative bleeding ( < 0.05), and total complication rate ( = 0.005) were lower in the observation group than in the control group. The observation group exhibited a marked increase in the GIQLI score, which was higher than the control group ( < 0.05). A lower one-year recurrence rate was determined in the observation group the control group ( = 0.027). Sphincter of Oddi dysfunction [odds ratio (OR) = 5.712, = 0.007] and the treatment scheme of open choledocholithotomy plus LC or OC (OR = 6.771, = 0.008) were the independent risk factors for one-year recurrence in patients after surgery.
LC plus CBDE for patients with EHBDSs can reduce stone residuals, intraoperative bleeding, complications, and postoperative recurrence.
在临床实践中，肝外胆管结石（EHBDS）的外科治疗仍存在争议。
探讨腹腔镜胆囊切除术（LC）联合胆总管探查术（CBDE）治疗EHBDS的疗效，并分析影响术后结石复发的危险因素。
选取2017年3月至2023年3月收治的82例EHBDS患者。其中，将接受开腹胆总管切开取石术联合LC或开腹胆囊切除术（OC）的患者设为对照组（n = 40），将接受LC联合CBDE的患者设为观察组（n = 42）。比较两组的手术效果，统计手术并发症及胃肠道生活质量指数（GIQLI）评分，并记录1年预后复发情况。采用单因素和多因素分析确定术后复发的独立因素。
两组结石残留率比较，差异无统计学意义（P > 0.05）。观察组手术时间（P < 0.05）、术中出血量（P < 0.05）和总并发症发生率（P = 0.005）均低于对照组。观察组GIQLI评分显著升高，高于对照组（P < 0.05）。观察组1年复发率低于对照组（P = 0.027）。Oddi括约肌功能障碍[比值比（OR） = 5.712，P = 0.007]和开腹胆总管切开取石术联合LC或OC的治疗方案（OR = 6.771，P = 0.008）是患者术后1年复发的独立危险因素。
LC联合CBDE治疗EHBDS患者可减少结石残留、术中出血、并发症及术后复发。
