【摘要】 目的:比较腹腔镜胆囊切除术(LC)联合胆总管探查术(LCBDE)与内镜下乳头括约肌切开取石术(EST)+LC治疗胆总管结石的有效性、安全性及经济性。方法:采用前瞻随机对照的方法,将确诊为胆总管结石的患者按照1:1的比例随机分配为两组,分别采用LC+LCBDE与EST+LC治疗,术后随访6个月,比较两组的相关临床指标。结果:共纳入110例患者。LC+LCBDE组平均手术时间(103.9±18.0)min,平均出血量(15.3±29.5)mL,中转3例(5.5%),平均住院时间(12.02±5.8)d,平均住院费用(32 116±6 503)元,随访未发现残余结石者。EST+LC组平均手术时间(175.2±10.5)min,平均出血量(6.8±7.0)mL,中转2例(3.6%),平均住院时间(11.9±3.0)d,平均住院费用(37 571±5 017)元,术后残余结石1例(1.8%)。两组手术时间、出血量、治疗费用方面有统计学差异(均P<0.05),其余指标均无统计学差异(均P>0.05)。结论:两种微创治疗方案在有效性及安全性方面无明显差异,LC+LCBDE较EST+LC的治疗费用明显减少。更多还原

【Abstract】 Objective: To evaluate the effectiveness, safety and economic value between laparoscopic cholecystectomy(LC)plus laparoscopic common bile duct exploration(LCBDE) and endoscopic sphincterotomy(EST) plus LC in treatment of common bile duct stones.Methods: Using a prospective, randomized controlled approach, patients with confirmed choledocholithiasis were randomly assigned in a 1:1 ratio to two groups to undergo LC+LCBD and EST+LC, respectively. Six-month postoperative follow-up was conducted. The main clinical variables between the two groups of patients were compared.Results: One hundred and ten patients were enrolled. In LC+LCBD group, the average operative time was(103.9±18.0) min, the average intraoperative blood loss was(15.3±29.5) mL, 3 cases(5.5%) had open conversion,the average length of hospital stay was(12.02±5.8) d and the average hospitalization cost was(32 116±6 503) yuan, and no residual stone was found during follow-up. In EST+LC group, the average operative was(175.2±10.5) min, the average intraoperative blood loss was(6.8±7.0) mL, 2 cases(3.6%) had open conversion, the average length of hospital stay was(11.9±3.0) d, the average hospitalization cost was(37 571±5 017) yuan, and residual stone was found in one case during follow-up. Between the two groups, the operative time, intraoperative blood loss and hospitalization cost had statistical difference(all P<0.05), while no statistical difference was noted in the remaining variables(all P>0.05).Conclusion: The two combined minimally invasive procedures show no obvious difference in effectiveness and safety. However, LC+LCBDE is preferentially recommended for its low costs.更多还原