摘要
目的:探讨腹腔镜胆囊切除术(LC)联合腹腔镜下胆总管取石术(LCBDE)与腹腔镜胆囊切除术联合十二指肠逆行胆胰造影(ERCP)取石术治疗胆囊结石伴肝外胆管结石的临床疗效。方法:选取胆囊结石伴肝外胆管结石患者92例,随机分为LC+LCBDE组和ERCP+LC组各46例。比较2组手术情况(术中失血量、净石率),术后恢复情况(肛门排气时间、术后首次下床活动时间、术后VAS评分)、并发症发生情况、总住院时间、总治疗费用。结果:2组并发症发生率、净石率比较,差异无统计学意义(P>0.05);ERCP+LC组术后1 d、3 d VAS评分[(5.19±0.91)vs(6.14±1.06)分、(3.71±0.85)vs(4.63±1.05)分]低于LC+LCBDE组(P<0.05),2组术后6 d VAS评分比较差异无统计学意义;ERCP+LC组术中失血量[(30.26±6.49)vs(60.52±10.52)mL]少于LC+LCBDE组(P<0.05);ERCP+LC组术后肛门排气时间[(17.85±3.63)vs(26.39±4.26)h]、首次下床活动时间[(15.03±1.97)vs(23.47±2.61)h]均明显短于LC+LCBDE组(P<0.05);LC+LCBDE组总治疗费用[(2.01±0.31)vs(3.02±0.42)万元]低于ERCP+LC组,且住总住院时间[(8.54±1.02)vs(11.21±1.31)d]短于ERCP+LC组(P<0.05)。结论:临床胆囊结石伴肝外胆管结石患者治疗中ERCP+LC较LC+LCBDE具有创伤小、患者恢复快等优势,LC+LCBDE相对于ERCP+LC具有费用更低及住院时间更短的优点。
Objective:To evaluate the clinical effect of LC+LCBDE/ERCP+LC in patients with gallstone and extrahepatic cholelithiasis.Methods:A total of 92 patients with gallbladder stones and extrahepatic bile duct stones were selected and randomly divided into the LC+LCBDE group of 46 patients and the ERCP+LC group of 46 patients.LC+LCBDE group received laparoscopic choledocholithotomy(LCBDE)+laparoscopic cholecystectomy(LC)while ERCP+LC group received duodenal retrograde cholangiopancreatography(ERCP)lithotripsy+LC.The surgical conditions(intraoperative blood loss,stone removal rate),postoperative recovery(anal exhaust time,postoperative first time out of bed,postoperative VAS score),complications,total hospitalization time and total treatment costs of the two groups were compared.Results:There was no significant difference in the complication rate and net stone rate between the two groups;The VAS scores[(5.19±0.91)vs(6.14±1.06),(3.71±0.85)vs(4.63±1.05)]in the ERCP+LC group were lower than those in the LC+LCBDE group(P<0.05).There was no significant difference in VAS score between the two groups at 6 days after operation;Intraoperative blood loss[(30.26±6.49)vs(60.52±10.52)mL]in the ERCP+LC group was less than that in the LC+LCBDE group;postoperative anal exhaust time[(26.39±4.26)vs(17.85±3.63)h],the time to get out of bed for the first time[(23.47±2.61)vs(15.03±1.97)h]were significantly shorter than those in the LC+LCBDE group(P<0.05);The total treatment cost of the LC+LCBDE group[(2.01±0.31)vs(3.02±0.42)10,000 yuan]was lower than the ERCP+LC group,and the total length of stay[(8.54±1.02)vs(11.21±1.31)d]shorter than ERCP+LC group(P<0.05).Conclusion:Compared with LC+LCBDE,ERCP+LC has the advantages of less trauma and faster recovery.LC+LCBDE has the advantages of lower cost and shorter hospital stay compared with ERCP+LC,which can be selected according to the needs of patients.
作者
陈正民
王法宝
周超毅
孙发缔
周少波
许兆龙
Chen Zhengmin;Wang Fabao;Zhou Chaoyi(Department of General Surgery,the Second Hospital Affiliated to Bengbu Medical College)
出处
《长治医学院学报》
2020年第1期40-43,共4页
Journal of Changzhi Medical College
基金
蚌埠医学院自然科学重点项目(BYKY2019163ZD)。
作者简介
通信作者:许兆龙,E-mail:xuzhaolong123@sina.com。
