“三步法”在十二指肠乳头括约肌切开术后行腹腔镜胆囊 切除术治疗胆囊结石合并胆总管结石手术时机选择的应用
| 作者: |
1汪晓峰,
1郑杨,
1陈嘉希,
1谭逸衍,
1陈芳,
1杨龙飞,
1朱湘南
1 南昌大学第四附属医院 普通外科，江西 南昌 330003 |
| 通讯: |
朱湘南
Email: xiaofengwang0211@163.com |
| DOI: | 10.3978/.2018.08.005 |
| 基金: | 江西省科技厅资助项目（20122BBG70120-2）。 |
摘要
目的：探讨采用“三步法”选择十二指肠乳头括约肌切开术（EST）后行腹腔镜胆囊切除术（LC）治疗胆囊结石并胆总管结石手术时机的有效性与安全性。
方法：选择 2012 年 12 月—2017 年 12 月明确诊断胆总管结石并胆囊结石的患者，随机分为试验组与对照组，两组患者均在完善术前准备后行逆行胰胆管造影（ERCP）/EST，试验组根据“三步法”决定LC 手术时间，对照组则在无临床症状、各项检查指标正常后行 LC。
结果：总共纳入患者 116 例，每组各 58 例，两组患者的基线资料具有可比性。与对照组比较，试 验 组 住 院 时 间 [12.0（11.0~15.0）d vs. 16.5（13.0~19.8）d，P<0.01] 及 住 院 总 费 用 [（2.8± 0.7）万元 vs.（3.2±0.8）万元，P=0.004] 均明显低降低（均 P<0.05）；LC 术中转开腹率、手术时间、术中出血量及术后并发症发生率两组间差异均无统计学意义（均 P>0.05）。
结论：根据 ERCP/EST 术中、术后情况为参考依据，采用“三步法”来选择 LC 的最佳手术时机可明显缩短住院时间，减少住院费用，手术效果及安全性与常规方法无异。
关键词：
胆囊结石病；胆总管结石病；胆囊切除术，腹腔镜；括约肌切开术，内窥镜
方法：选择 2012 年 12 月—2017 年 12 月明确诊断胆总管结石并胆囊结石的患者，随机分为试验组与对照组，两组患者均在完善术前准备后行逆行胰胆管造影（ERCP）/EST，试验组根据“三步法”决定LC 手术时间，对照组则在无临床症状、各项检查指标正常后行 LC。
结果：总共纳入患者 116 例，每组各 58 例，两组患者的基线资料具有可比性。与对照组比较，试 验 组 住 院 时 间 [12.0（11.0~15.0）d vs. 16.5（13.0~19.8）d，P<0.01] 及 住 院 总 费 用 [（2.8± 0.7）万元 vs.（3.2±0.8）万元，P=0.004] 均明显低降低（均 P<0.05）；LC 术中转开腹率、手术时间、术中出血量及术后并发症发生率两组间差异均无统计学意义（均 P>0.05）。
结论：根据 ERCP/EST 术中、术后情况为参考依据，采用“三步法”来选择 LC 的最佳手术时机可明显缩短住院时间，减少住院费用，手术效果及安全性与常规方法无异。
Choosing timing for laparoscopic cholecystectomy following endoscopic sphincterotomy in treatment of simultaneous cholecystolithiasis and choledocholithiasis by using “three-step method”
CorrespondingAuthor:ZHU Xiangnan Email: xiaofengwang0211@163.com
Abstract
Objective: To investigate the efficacy and safety of using “three-step method” to determine the timing for laparoscopic cholecystectomy (LC) following endoscopic sphincterotomy (EST) in treatment of simultaneous cholecystolithiasis and choledocholithiasis.
Methods: Patients who had been defi nitely diagnosed with concomitant gallbladder and common bile duct stones during December 2012 to December 2017 were selected and randomly allocated into study group and control group. Patients in both groups underwent endoscopic retrograde cholangiopancreaticography (ERCP) and EST after completion of the preoperative preparation. Time interval for following LC in study group was determined by using the “three-step method” in study group, while LC was performed after the complete disappearance of clinical symptoms and the full recovery of all laboratory test results in control group.
Results: A total of 116 patients were consented for the study, with 58 patients each in both groups. The baseline data were comparable between the two groups. In study group compared with control group, the length of hospital stay [12.0 (11.0–15.0) d vs. 16.5 (13.0–19.8) d, P<0.01] and total hospitalization cost [ (28 000±7 000) yuan vs. (32 000±8 000) yuan, P=0.004]were significantly reduced (both P<0.05), but the LC conversion rate, operative time, intraoperative blood loss and incidence of postoperative complication showed no significant differences (all P>0.05).
Conclusion: Using “three-step method” to determine the optimal timing for LC according to the intra- and postoperative conditions of ERCP/EST can effectively reduce the length of hospital stay and hospitalization cost, and meanwhile, it has similar efficacy and safety to those by conventional method.
Keywords：
Cholecystolithiasis; Choledocholithiasis; Cholecystectomy
Laparoscopic; Sphincterotomy
Endoscopic
Methods: Patients who had been defi nitely diagnosed with concomitant gallbladder and common bile duct stones during December 2012 to December 2017 were selected and randomly allocated into study group and control group. Patients in both groups underwent endoscopic retrograde cholangiopancreaticography (ERCP) and EST after completion of the preoperative preparation. Time interval for following LC in study group was determined by using the “three-step method” in study group, while LC was performed after the complete disappearance of clinical symptoms and the full recovery of all laboratory test results in control group.
Results: A total of 116 patients were consented for the study, with 58 patients each in both groups. The baseline data were comparable between the two groups. In study group compared with control group, the length of hospital stay [12.0 (11.0–15.0) d vs. 16.5 (13.0–19.8) d, P<0.01] and total hospitalization cost [ (28 000±7 000) yuan vs. (32 000±8 000) yuan, P=0.004]were significantly reduced (both P<0.05), but the LC conversion rate, operative time, intraoperative blood loss and incidence of postoperative complication showed no significant differences (all P>0.05).
Conclusion: Using “three-step method” to determine the optimal timing for LC according to the intra- and postoperative conditions of ERCP/EST can effectively reduce the length of hospital stay and hospitalization cost, and meanwhile, it has similar efficacy and safety to those by conventional method.