腹腔镜胆总管切开探查取石+腹腔镜胆囊切除术与经内镜逆行胰胆管造影/内镜下括约肌切开取石+腹腔镜胆囊切除术治疗结石性急性梗阻性化脓性胆管炎的疗效比较

doi:10.3969/j.issn.1005-6483.2021.07.008

摘要/Abstract

摘要： 目的比较腹腔镜胆总管切开探查取石(LCBDE)+腹腔镜胆囊切除术(LC)和经内镜逆行胰胆管造影/内镜下括约肌切开取石(ERCP/EST)+LC两种微创术式治疗结石性急性梗阻性化脓性胆管炎(AOSC)的临床疗效。
方法结石性AOSC病人70例，按治疗方式分为LCBDE+LC组（36例）和ERCP/EST+LC组（34例），比较两组手术总成功率、一次手术成功率、手术时间、术中出血量、术后并发症发生率、住院时间及住院费用方面的差异。
结果 LCBDE+LC组一次手术成功率高于ERCP/EST+LC组，住院时间和住院费用少于ERCP/EST+LC组，但术中出血量多于ERCP/EST+LC组，差异有统计学意义(P＜0.05)，两组手术总成功率、手术时间及术后并发症发生率的比较，差异均无统计学意义(P＞0.05)。
结论 LCBDE+LC比ERCP/EST+LC治疗结石性AOSC一次手术成功率高、住院时间短、住院费用低。

关键词: 急性梗阻性化脓性胆管炎, 结石, 腹腔镜手术, 内镜治疗, 疗效

Abstract: Objective To compare the clinical effect of laparoscopic common bile duct exploration and stone extraction(LCBDE) combined with laparoscopic cholecystectomy(LC) compared with endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy(ERCP/EST) combined with laparoscopic cholecystectomy(LC) in the treatment of calcalous acute obstructive suppurative cholangitis(AOSC).
Methods The clinical data of 70 patients with calcalous AOSC in Songjiang Hospital affillated to Shanghai Jiaotong University School of Medicine were analyzed retrospectively.The cases were divided into the LCBDE+LC group(36 cases) and the ERCP/EST+LC group(34 cases) according to different treatment methods.The total operative success rate，primary operative success rate，operation time，intraoperative bleeding volume，postoperative complications rate，hospitalization time and hospitalization cost of the two groups were compared.
Results In LCBDE+LC group，the success rate of primary operation was higher than that of ERCP/EST+LC group，the length and cost of hospital stay were less than that of ERCP/EST+LC group，but the intraoperative bleeding volume was more than that of ERCP/EST+LC group.The difference was statistically significant(P＜0.05).There were no differences in the total operative success rate，operation time and postoperative complications rate between LCBDE+LC group and ERCP/EST+LC group(P＞0.05).
Conclusions Compared with ERCP/EST+LC in the treatment of calcalous AOSC，LCBDE+LC has the advantages of higher success rate of primary operation，shorter hospitalization time and lower hospitalization cost.

Key words: acute obstructive suppurative cholangitis, calculus, laparoscopic surgery, endoscopic therapy, curative effect

顾越雷郭德凯李镇伽江雨波刘蕾. 腹腔镜胆总管切开探查取石+腹腔镜胆囊切除术与经内镜逆行胰胆管造影/内镜下括约肌切开取石+腹腔镜胆囊切除术治疗结石性急性梗阻性化脓性胆管炎的疗效比较[J]. 临床外科杂志, 2021, 29(7): 622-625.

GU Yuelei, GUO Dekai, LI Zhenjia, et al.. Comparison of the curative effect of LCBDE+LC and ERCP/EST+LC in the treatment of calculous acute obstructive suppurative cholangitis[J]. JOURNAL OF CLINICAL SURGERY, 2021, 29(7): 622-625.

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