腹腔镜联合十二指肠镜同期手术治疗胆囊结石合并胆总管结石的临床效果
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摘要
目的:探讨腹腔镜联合十二指肠镜同期手术治疗胆囊结石合并胆总管结石的临床效果。方法:137例胆囊结石合并胆总管结石患者,分为分期手术组(先ERCP胆总管取石,然后行腹腔镜胆囊切除)44例和同期手术组(同时行腹腔镜胆囊切除和十二指肠镜胆总管取石)93例,从手术时间、术中出血量、术后血淀粉酶、术后并发症发生率、手术中转率、住院时间等观察两组临床数据。结果:137例患者手术均无死亡发生,同期手术组患者手术时间缩短,明显减少住院时间,同时术后胰腺炎等并发症发生率低,有统计学差异(P<0. 05)。术中出血量、手术中转率、术后血淀粉酶无统计学差异。结论:腹腔镜联合十二指肠镜同期手术治疗胆囊结石合并胆总管结石能够减少病人痛苦,减少并发症的发生,缩短患者手术时间和住院时间,更进一步体现出微创的理念。
Objective: To explore the clinical effect of laparoscopic cholecystectomy(LC) combined with duodenoscopic procedures in the treatment of cholecysto-choledocholithiasis.Methods: We retrospectively analyzed the clinical data of 137 patients with cholecysto-choledocholithiasis from January 2016 to December 2018 in this study. Patients were scheduled for either one-stage group(simultaneous intra-operative ERCP combined with LC) or two-stage group(sequential preoperative ERCP followed by LC). The one-stage group included 93 cases, whereas the two-stage group contained 44 cases. The operation time, intra-operative bleeding volume, blood amylase, incidence of post-operative complication, operative conversion rate, and length of hospital stay were compared between the two groups.Results: Finally 137 patients were enrolled in this study. The baseline was similar between the two groups. There is no patient death in both groups. As compared with that respectively in two-stage group, the operation time, incidence of post-operative complication and length of hospital stay in onestage operation group were much better, and there were significant difference between the two groups(P<0. 05). However, no significant differences were found in the intra-operative bleeding volume,blood amylase, and operative conversion rate(P>0. 05).Conclusion: The one-stage procedure, simultaneous intra-operative ERCP combined with LC surgery, is a safe and economical approach for cholecysto-choledocholithiasis treatment with lower incidence of postoperative complication and shorter operation time and hospital stay. Moreover, it can alleviate pain of patients by reducing the number of operations and minimizing invasion.
Objective: To explore the clinical effect of laparoscopic cholecystectomy(LC) combined with duodenoscopic procedures in the treatment of cholecysto-choledocholithiasis.Methods: We retrospectively analyzed the clinical data of 137 patients with cholecysto-choledocholithiasis from January 2016 to December 2018 in this study. Patients were scheduled for either one-stage group(simultaneous intra-operative ERCP combined with LC) or two-stage group(sequential preoperative ERCP followed by LC). The one-stage group included 93 cases, whereas the two-stage group contained 44 cases. The operation time, intra-operative bleeding volume, blood amylase, incidence of post-operative complication, operative conversion rate, and length of hospital stay were compared between the two groups.Results: Finally 137 patients were enrolled in this study. The baseline was similar between the two groups. There is no patient death in both groups. As compared with that respectively in two-stage group, the operation time, incidence of post-operative complication and length of hospital stay in onestage operation group were much better, and there were significant difference between the two groups(P<0. 05). However, no significant differences were found in the intra-operative bleeding volume,blood amylase, and operative conversion rate(P>0. 05).Conclusion: The one-stage procedure, simultaneous intra-operative ERCP combined with LC surgery, is a safe and economical approach for cholecysto-choledocholithiasis treatment with lower incidence of postoperative complication and shorter operation time and hospital stay. Moreover, it can alleviate pain of patients by reducing the number of operations and minimizing invasion.
引文
[1]商昌珍,陈亚进.胆囊结石合并肝外胆管结石的诊治策略[J].中国实用外科杂志,2015,35(9):951-954.Shang CZ, Chen YJ. Diagnosis and management strategies of cholecysto-choledocholithiasis[J]. Chinese Journal of Practical Surgery, 2015,35(9):951-954.
[2] Prasson P, Bai X, Zhang Q, et al. One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi:a systemic review and meta-analysis[J]. Surg Endosc, 2016,30(8):3 582-3 590.
[3] European Association for the Study of the Liver(EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones[J]. J Hepatol, 2016,65(1):146-181.
[4] Mine T, Morizane T, Kawaguchi Y, et al. Clinical practice guideline for post-ERCP pancreatitis[J]. J Gastroenterol,2017,52(9):1 013-1 022.
[5]王宾,刘振杰,吕云霄,等.术前与术中内镜下括约肌切开术治疗胆囊结石合并胆总管结石的荟萃分析[J].中华医学杂志,2015,95(18):1 425-1 429.Wang B,Liu ZJ, LüYX, et al. A meta-analysis of preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones[J]. National Medical Journal of China,2015,95(18):1 425-1 429.
[6]郭欣,吕小惠,陈芦斌.两种微创术式治疗胆囊结石合并胆总管结石临床疗效的比较[J].腹腔镜外科杂志,2016,21(12):919-922.Guo X, LüXH, Chen LB. Clinical comparative analysis on two kinds of minimally invasive treatment for cholecystolithiasis combined with choledocholithiasis[J].Journal of Laparoscopic Surgery, 2016, 21(12):919-922.
[7] Tzovaras G, Baloyiannis I, Zachari E, et al. Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis:interim analysis of a controlled randomized trial[J]. Ann Surg, 2012,255(3):435-439.
[8] Yi HJ, Hong G, Min SK, et al. Long-term outcome of primary closure after laparoscopic common bile duct exploration combined with choledochoscopy[J]. Surg Laparosc Endosc Percutan Tech, 2015,25:250-253.
[2] Prasson P, Bai X, Zhang Q, et al. One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi:a systemic review and meta-analysis[J]. Surg Endosc, 2016,30(8):3 582-3 590.
[3] European Association for the Study of the Liver(EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones[J]. J Hepatol, 2016,65(1):146-181.
[4] Mine T, Morizane T, Kawaguchi Y, et al. Clinical practice guideline for post-ERCP pancreatitis[J]. J Gastroenterol,2017,52(9):1 013-1 022.
[5]王宾,刘振杰,吕云霄,等.术前与术中内镜下括约肌切开术治疗胆囊结石合并胆总管结石的荟萃分析[J].中华医学杂志,2015,95(18):1 425-1 429.Wang B,Liu ZJ, LüYX, et al. A meta-analysis of preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones[J]. National Medical Journal of China,2015,95(18):1 425-1 429.
[6]郭欣,吕小惠,陈芦斌.两种微创术式治疗胆囊结石合并胆总管结石临床疗效的比较[J].腹腔镜外科杂志,2016,21(12):919-922.Guo X, LüXH, Chen LB. Clinical comparative analysis on two kinds of minimally invasive treatment for cholecystolithiasis combined with choledocholithiasis[J].Journal of Laparoscopic Surgery, 2016, 21(12):919-922.
[7] Tzovaras G, Baloyiannis I, Zachari E, et al. Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis:interim analysis of a controlled randomized trial[J]. Ann Surg, 2012,255(3):435-439.
[8] Yi HJ, Hong G, Min SK, et al. Long-term outcome of primary closure after laparoscopic common bile duct exploration combined with choledochoscopy[J]. Surg Laparosc Endosc Percutan Tech, 2015,25:250-253.