LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石的疗效分析
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摘要
目的探讨腹腔镜胆总管探查取石术+腹腔镜胆囊切除术(LCBDE+LC)与经内镜逆行胰胆管造影/内镜下十二指肠乳头括约肌切开术+腹腔镜胆囊切除术(ERCP/EST+LC)两种手术方式治疗胆囊结石合并胆总管结石的疗效。方法收集2010年01月至2015年12月在沧州市人民医院行两种不同术式治疗胆囊结石合并胆总管结石的患者资料70例。其中38例行ERCP/EST+LC,32例行LCBDE+LC,对比两组的手术时间、术中出血量、住院时间、胃肠道功能恢复时间、术后胆漏发生率、胰腺炎发生率等指标。结果手术时间:ERCP/EST+LC组多于LCBDE+LC组手术时间,差异有统计学意义(P<0.05),术中出血量:两组差异无统计学意义(P<0.05);术后胃肠道功能恢复时间:LC+LCBDE组与ERCP/EST+LC组恢复时间相当,无统计学意义(P>0.05);术后住院时间,LC+LCBDE组与ERCP/EST+LC组住院时间相当,无统计学意义(P>0.05);LCBDE+LC组术后发生胆瘘5例,ERCP/EST+LC组术后发生急性胰腺炎4例,胆瘘1例,两组通过对比,ERCP/EST+LC组胰腺炎发生率更高,LCBDE+LC组胆漏发生率更高,差异有统计学意义(P<0.05)。结论结石大、数量多、存在不同程度的十二指肠乳头狭窄的病人优先选择LC+LCBDE术式,减少手术时间及术后胰腺炎的发生率;LCBDE+LC术后一期缝合胆总管,常规放置T管引流,减小胆道内压力预防胆漏的发生,两种术式各自有各自的优缺点,针对不同患者,个体化诊疗,力争达到最优原则。
Objective To investigate laparoscopic cholecystectomy(LCBDE+LC) and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy for laparoscopic choledocholithotomy The efficacy of ERCP/EST+LC) in the treatment of choledocholithiasis combined with choledocholithiasis. Methods From January 2010 to December 2015, 70 patients with choledocholithiasis complicated with choledocholithiasis were treated with two different methods in Cangzhou people's Hospital.38 of them underwent ERCP/EST+LC,32 routine. LCBDE+LC was used to compare the operative time, intraoperative bleeding,hospitalization time, recovery time of gastrointestinal function, postoperative bile leakage rate and pancreatitis rate between the two groups. Results The operative time was the same between the two groups(P>0.05), the intraoperative bleeding volume in the ERCP/EST+LC group was less than that in the LC+LCBDE group(P<0.05), and there was no significant difference between the two groups(P<0.05), but there was no significant difference in the operative time between the two groups(P>0.05). The recovery time of gastrointestinal function after operation in: LC+LCBDE group was similar to that in ERCP/EST+LC group, but there was no statistical significance. The length of hospital stay in, LC+LCBDE group was similar to that in ERCP/EST+LC group(P>0.05), and there was no significant difference between the two groups(P>0.05). There were 5 cases of postoperative biliary fistula in LCBDE+LC group, 4 cases of acute pancreatitis and 1 case of biliary fistula in ERCP/EST LC group. The incidence of pancreatitis in ERCP/EST+LC group was higher than that in, LCBDE+LC group, and the incidence of bile leakage in, LCBDE+LC group was higher than that in, LCBDE+LC group. There was statistical significance(P<0.05). Conclusion LC+LCBDE is preferred for patients with large stones, large numbers and different degrees of duodenal papillary stenosis to reduce the operation time and the incidence of post-operative pancreatitis. After LCBDE+LC, the common bile duct is sutured in one stage, and T-tube drainage is placed routinely to reduce the pressure in the biliary tract to prevent bile leakage. Their advantages and disadvantages, for different patients, individualized diagnosis and treatment, strive to achieve the optimal principle.
Objective To investigate laparoscopic cholecystectomy(LCBDE+LC) and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy for laparoscopic choledocholithotomy The efficacy of ERCP/EST+LC) in the treatment of choledocholithiasis combined with choledocholithiasis. Methods From January 2010 to December 2015, 70 patients with choledocholithiasis complicated with choledocholithiasis were treated with two different methods in Cangzhou people's Hospital.38 of them underwent ERCP/EST+LC,32 routine. LCBDE+LC was used to compare the operative time, intraoperative bleeding,hospitalization time, recovery time of gastrointestinal function, postoperative bile leakage rate and pancreatitis rate between the two groups. Results The operative time was the same between the two groups(P>0.05), the intraoperative bleeding volume in the ERCP/EST+LC group was less than that in the LC+LCBDE group(P<0.05), and there was no significant difference between the two groups(P<0.05), but there was no significant difference in the operative time between the two groups(P>0.05). The recovery time of gastrointestinal function after operation in: LC+LCBDE group was similar to that in ERCP/EST+LC group, but there was no statistical significance. The length of hospital stay in, LC+LCBDE group was similar to that in ERCP/EST+LC group(P>0.05), and there was no significant difference between the two groups(P>0.05). There were 5 cases of postoperative biliary fistula in LCBDE+LC group, 4 cases of acute pancreatitis and 1 case of biliary fistula in ERCP/EST LC group. The incidence of pancreatitis in ERCP/EST+LC group was higher than that in, LCBDE+LC group, and the incidence of bile leakage in, LCBDE+LC group was higher than that in, LCBDE+LC group. There was statistical significance(P<0.05). Conclusion LC+LCBDE is preferred for patients with large stones, large numbers and different degrees of duodenal papillary stenosis to reduce the operation time and the incidence of post-operative pancreatitis. After LCBDE+LC, the common bile duct is sutured in one stage, and T-tube drainage is placed routinely to reduce the pressure in the biliary tract to prevent bile leakage. Their advantages and disadvantages, for different patients, individualized diagnosis and treatment, strive to achieve the optimal principle.
引文
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[6]杨成俊,张戈,张丽.消化内镜技术在胆胰疾病中的应用分析[J].世界最新医学信息文摘,2015,15(75):23-24.
[7]Li MK,Tang CN,Lai EC,Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era:a systematic review[J].AsianJEndosc Surg,2011,4(2):53-58.
[8]De Palma GD.Minimally invasive treatment of cholecystocholedoca lithiasis:The point of view of the surgical endoscopist[J].World J Gastrointest Surg,2013,5(6):161-163.
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[10]Chander J,Vindal A,Lal P,et al.Laparoscopic management of CBD stones:an Indian experience[J].Surg Endosc,2011,25(1):172-181.
[11]Poulose BK,Speroff T,Holzman MD.Optimizing choledocholithiasis management:a cost-effectiveness analysis[J].Arch Surg,2007,142(1):43-48.
[12]Schiphorst AHW,Besselink MGH,Boerma D,et al.Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones[J].Surg Endosc,2008,22(9):2046-2050.
[13]Rogers SJ,Cello JP,Horn JK,et al.Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease[J].Arch Surg,2010,145(1):28-33.
[14]Feng WM,Bao Y,Tang CW,et al.Optimal selection of methods for miniinvasive treatment of extrahepatic bile duct stones[J].Hepatogastroenterolo gy,2014,61(130):299-303.
[15]谢浩,龙昊,宋正伟,等.腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床疗效分析[J].重庆医学,2013,20(42):2359-2363.
[16]许松欣,丁岩冰.腹腔镜联合内镜治疗胆囊结石合并胆总管结石的诊治进展[J].中国微创外科杂志,2015,15(4):376-379.
[2]Dion YM,Ratelle R,Morin J,et al.Common bile duct exploration:the place of laparoscopic choledochotomy[J].Surg Laparosc Endosc,1994,4(6):419-424.
[3]Sarli L,Sabadini G,Pietra N,et al.Laparoscopic cholecystectomy and endoscopic sphincterotomyunder a single anesthetic:a case report[J].Surg Laparosc Endosc,1995,5(1):68-71.
[4]Nakajima M,Kizu M,Akasaka Y,et al.Five years experience of endoscopic sphincterotomy in Japan:a collective study from 25 centres[J]Endoscopy,1979,11(2):138-141.
[5]王毅,简志祥.采用X-Cone的经脐单孔腹腔镜与传统腹腔镜胆囊切除术的比较[J].中国微创外科杂志,2013,13(4):307-310.
[6]杨成俊,张戈,张丽.消化内镜技术在胆胰疾病中的应用分析[J].世界最新医学信息文摘,2015,15(75):23-24.
[7]Li MK,Tang CN,Lai EC,Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era:a systematic review[J].AsianJEndosc Surg,2011,4(2):53-58.
[8]De Palma GD.Minimally invasive treatment of cholecystocholedoca lithiasis:The point of view of the surgical endoscopist[J].World J Gastrointest Surg,2013,5(6):161-163.
[9]Dasari B,Tan CJ,Gurusamy ks,et al.Surgical versus endoscopic treatment of bile duct stones[J].Cochrane Database Syst Rev,2013,9:CD003327.
[10]Chander J,Vindal A,Lal P,et al.Laparoscopic management of CBD stones:an Indian experience[J].Surg Endosc,2011,25(1):172-181.
[11]Poulose BK,Speroff T,Holzman MD.Optimizing choledocholithiasis management:a cost-effectiveness analysis[J].Arch Surg,2007,142(1):43-48.
[12]Schiphorst AHW,Besselink MGH,Boerma D,et al.Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones[J].Surg Endosc,2008,22(9):2046-2050.
[13]Rogers SJ,Cello JP,Horn JK,et al.Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease[J].Arch Surg,2010,145(1):28-33.
[14]Feng WM,Bao Y,Tang CW,et al.Optimal selection of methods for miniinvasive treatment of extrahepatic bile duct stones[J].Hepatogastroenterolo gy,2014,61(130):299-303.
[15]谢浩,龙昊,宋正伟,等.腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床疗效分析[J].重庆医学,2013,20(42):2359-2363.
[16]许松欣,丁岩冰.腹腔镜联合内镜治疗胆囊结石合并胆总管结石的诊治进展[J].中国微创外科杂志,2015,15(4):376-379.