关键词: 胆总管结石, 胆囊切除术, 胆总管切开取石术, 内镜下逆行胰胆管造影取石术, 腹腔镜下胆总管探查术, 疗效对比, 倾向性评分匹配

Abstract: Objective   To compare the efficacy of three different surgical methods in the treatment of common bile duct stones after cholecystectomy:open common bile duct exploration (OCBDE),endoscopic retrograde cholangiopancreatography and papillary sphincterotomy (ERCP/EST),and laparoscopic common bile duct exploration (LCBDE). Methods   The clinical data of 109 cases of recurrent choledocholithiasis after cholecystectomy treated in our hospital from July 2016 to July 2020 were analyzed retrospectively.Among them,33 cases were ERCP,40 cases were OCBDE group,and 36 cases were LCBDE.The influence of confounding factors among the groups was balanced by the tendentious score matching method (PSM),and the clinical efficacy and complications of the three groups after matching were compared.  Results   28 patients were included in each group by PSM method,and the baseline data of the three groups were not statistically significant(P>0.05).No statistical difference was found in the success rate of operation and stone clearance rate among three groups (P>0.05).The specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in ERCP group were lower/shorter than those in OCBSE group and LCBDE group,with obvious difference (P<0.05),while the specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in LCBDE group were lower/shorter than those in OCBSE group,with obvious difference (P<0.05).The incidence rate of perioperative complications of ERCP group showed no obvious difference with that of other 2 groups (P>0.05),while the incidence rate of postoperative complications in LCBDE group was lower than that in OCBDE group,with statistical difference (P<0.05).Postoperative follow-up showed that the recurrence rate of common bile duct stones in ERCP group was higher than OCBDE and LCBDE groups,with statistical difference (P<0.05),while the recurrence rate yielded no statistical difference between OCBDE group and LCBDE group (P>0.05). Conclusion   ERCP,OCBDE and LCBDE can effectively remove common bile duct stones after gallbladder surgery.ERCP surgery is less traumatic,but it is prone to severe complications such as acute pancreatitis and hyperamylasemia after surgery,and the residual rate of stones after surgery is high.LCBDE has the advantage of micro-invasive surgery than OCBDE,but it is not suitable for patients with severe abdominal adhesion.It is recommended that the operator select an appropriate surgical method according to the specific situation of the patient.

Key words: choledocholithiasis, cholecystectomy, choledocholithotomy, endoscopic retrograde cholangiopancreatography, laparoscopic common bile duct exploration, comparison of curative effects, tendency score matching