两种手术方法处理腹腔镜胆囊切除术后胆总管残余结石患者临床疗效比较

摘要

目的 分析比较经内镜逆行性胰胆管造影(ERCP)下取石与开腹胆道探查(CBDE)治疗腹腔镜胆囊切除术(LC)后胆总管残余结石患者的临床疗效.方法 2015年2月～2016年12月我院收住的经LC术后存在胆总管残余结石患者84例,其中38例采取CBDE法(A组)治疗,46例采取ERCP下取石(B组).结果 B组术中出血量明显少于A组[(3.4±1.3)ml对(124.2±65.8)ml,P＜0.05],手术时间[(34.8±4.2)min对(123.3±15.8)min,P＜0.05]、术后排气时间[(1.0±0.7)h对(42.6±9.1)h,P＜0.05]和住院时间[(4.9±3.5)d对(9.3±4.3)d,P＜0.05]均明显短于 A组;术后 1 w,B组血清 GGT水平为(63.7±7.5)IU/L,与 A组的(70.2±7.9)IU/L 比无显著性相差(P＞0.05),血清ALP水平为(105.6±11.5)IU/L,与A组的(115.4±12.8)IU/L比无显著性相差(P＞0.05);A组并发症发生率为23.7%、结石再复发率为5.3%,而B组分别为15.2%和6.5%,两组比较无显著性差异(P＞0.05).结论 相对于CBDE 术,采用ERCP 下取石处理经LC 术后胆总管残余结石患者可有效降低术中出血量,缩短手术时间,并因可反复进行而具有优势.%Objective To analyze the efficacy of stone removal under endoscopic retrograde cholangiopancreatography(ERCP)and open common bile duct exploration(CBDE)in the treatment of patients with common bile duct residual stones after laparoscopic cholecystectomy (LC). Methods 84 patients with common bile duct residual stones after LC in our hospital between February 2015 and December 2016 were selected in this study,and 38 cases of them were given CBDE (group A) and 46 cases were treated with stone removal under ERCP (group B). Results The average intraoperative bleeding volume in the group B was significantly lesser than that in the group A [(3.4±1.3)ml vs.(124.2± 65.8)ml],the operative time [(34.8±4.2)min vs.(123.3±15.8)min], the exhaust time [(1.0±0.7)h vs.(42.6±9.1)h] and the hospital stay [(4.9±3.5)d vs.(9.3±4.3)d] in group B were all significantly shorter than those in group A(all P<0.05);at the end of one week,serum levels of GGT [(63.7±7.5) IU/L vs. (70.2±7.9)IU/L] and ALP [(105.6± 11.5)IU/L vs. (115.4±12.8)IU/L] in group B were not significantly different as compared to those in group A (P>0.05);there were no significant differences as respect to the stone removal success(100.0% vs. 97.8%),incidence of complications (23.7% vs. 15.2%) and stone recurrence (5.3% vs. 6.5%) between the two groups (P>0.05). Conclusions Stone removal under ERCP for patients with common bile duct residual stones after LC can reduce the intraoperative bleeding,with shorten operative time and hospital stay, which can be repeatedly conducted for the recurrence or residual stones in common bile duct.