【摘要】 目的 比较腹腔镜胆囊切除+胆总管切开取石+胆总管一期缝合术(laparoscopic cholecystectomy+laparoscopic common bile duct exploration+primary duct closure, LC+LCBDE+PDC)与内镜逆行性胆胰管造影/乳头括约肌切开+腹腔镜胆囊切除术(endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy+laparoscopic cholecystectomy,ERCP/EST+LC)两种手术方式治疗胆囊结石合并细径(胆总管直径≤8 mm)胆总管结石的临床疗效。方法 回顾性分析2018年1月至2021年12月三二〇一医院收治的116例胆囊结石合并细径胆总管结石患者的临床资料，55例行LC+LCBDE+PDC术(LCBDE组), 61例行ERCP/EST+LC术(ERCP组),比较两组的临床效果。结果 两组患者年龄、性别、胆总管直径、结石数量、最大结石直径、总胆红素、直接胆红素、白细胞计数比较无统计学差异(P>0.05)。LCBDE组和ERCP组的手术成功率为96.4%vs.100%;平均手术时间为(109.87±26.75)min vs.(108.26±24.44)min;中位手术出血量为70(35,90)mL vs.55(35,85)mL,组间比较无统计学差异(P>0.05)。两组比较，LCBDE组术后平均住院时间短，为(6.55±1.86)d vs.(7.48±1.70)d;中位住院费用低，为13 731(9 241,20 656)元vs. 16 872(12 998,22 647.5)元，差异有统计学意义(P<0.05)。在并发症方面，LCDBE组胆道狭窄率高于ERCP组(7.3%vs.0),差异有统计学意义(P<0.05);而结石残余率(3.6%vs. 3.3%)、胆漏发生率(5.5%vs.0)、胰腺炎发生率(1.8%vs. 3.3%)两组比较均无统计学差异(P>0.05)。结论 LC+LCBDE+PDC治疗胆囊结石合并细径胆总管结石具有安全有效、住院时间短、费用低的优势；对于胆囊结石合并管径小于6 mm的胆总管结石首选ERCP/EST+LC。更多还原

【Abstract】 Objective To compare the clinical results of laparoscopic cholecystectomy + laparoscopic common bile duct exploration + primary duct closure(LC+LCBDE+PDC) and endoscopic retrograde cholangiopancreatography/papillary sphincter dissection + laparoscopic cholecystectomy(ERCP/EST+LC) for the treatment of cholecystolithiasis combined with common bile duct calculus with fine diameter(common bile duct diameter ≤8 mm). Methods A retrospective analysis was carried out of clinical data in 116 patients with cholecystolithiasis combined with fine diameter common bile duct calculus admitted to 3201 Hospital from January 2018 to December 2021. The were 55 patients underwent LC+LCBDE+PDC( LCBDE group) and61 patients underwent ERCP/EST + LC( ERCP group),and the differences in the relevant indexes between the two groups were compared. Results There was no statistical difference between the two groups in terms of age,gender,common bile duct diameter,number of stones,maximum stone diameter,total bilirubin,direct bilirubin,and white blood cell count( P> 0.05). There was no statistical difference in the success rate( 96.4% vs. 100%),operative time [( 109.87±26.75) min vs.( 108.26±24. 44) min],and operative bleeding( 70 m L vs. 55 m L) between the two groups( P>0.05). LCBDE group had a shorter postoperative hospital stay[( 6.55±1.86) d vs.( 7.48±1.70) d]and a lower median hospitalization cost( 13 731 yuan vs. 16 872yuan),and the difference was statistically significant( P< 0.05). LCDBE group had a higher biliary stricture rate( 7.3% vs. 0),and the difference was statistically significant( P<0.05). There was no statistical difference in the stone residual rate( 3.6% vs. 3.3%),pancreatitis incidence( 1.8% vs. 3.3%),and bile leakage incidence( 5.5% vs. 0) in LCDBE group and ERCP group( P>0.05). Conclusion LC+LCBDE+PDC for cholecystolithiasis combined with vommon bile duct fine diameter calculus is safe and effective,with short hospital stay and low cost. ERCP/EST+LC is preferred for cholecystolithiasis combined with common bile duct calculus less than 6 mm in diameter.更多还原