两种组合微创技术治疗胆总管结石比较的前瞻性研究
| 作者: |
1罗浩,
1孙竹峰,
1万柳华,
1黄建伟,
1冯矗,
1刘古月
1 上海市普陀区人民医院 普通外科，上海 200060 |
| 通讯: |
罗浩
Email: luohao0926@163.com |
| DOI: | 10.3978/.2018.02.002 |
| 基金: | 上海市卫生计生系统科研基金资助项目（20124296）。 |
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。
关键词：
胆总管结石病；最小侵入性外科手术；前瞻性研究
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。
Comparison of two types of combined minimally invasive procedures in treatment of choledocholithiasis: a prospective study
CorrespondingAuthor:LUO Hao Email: luohao0926@163.com
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.
Keywords：
Choledocholithiasis; Minimally Invasive Surgical Procedures; Prospective Studies
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.