LC联合术中ERCP与LC联合LTCBDE治疗胆囊结石合并非扩张型胆总管结石的效果比较:一项倾向性评分匹配研究OA

Objective To compare the safety and efficacy of laparoscopic cholecystectomy(LC)combined with intraoperative endoscopic retrograde cholangiopancreatography(ERCP)versus LC combined with laparoscopic transcystic common bile duct exploration(LTCBDE)in the treatment of gallbladder stones combined with non-dilated common bile duct stones.Methods The clinical data of 312 patients,who diagnosed with gallbladder stones combined with non-dilated common bile duct stones and underwent LC combined with intraoperative ERCP or LC combined with LTCBDE in Shandong Provincial Third Hospital from October 2022 to October 2024,were retrospectively collected.Patients were divided into the LC+intraoperative ERCP group(n=160)and the LC+LTCBDE group(n=152)according to the surgical methods.Propensity score matching(PSM)was conducted at a ratio of 1∶1,with the caliper value of 0.1.The intraoperative and postoperative indicators and the postoperative complications between the two groups after PSM were compared.Results After PSM,131 cases were included in both groups.There was no statistically significant difference in the surgical success rate(99.2%vs 98.5%,P=1.000)and stone clearance rate(100.0%vs 99.2%,P=1.000)between the LC+intraoperative ERCP group and the LC+LTCBDE group(P>0.05).The operation time in the LC+introperative ERCP group was longer than that in the LC+LTCBDE group[(99.1±28.9)min vs(84.2±24.8)min,t=4.492,P<0.01],while the postoperative hospitalization time in the LC+intraoperative ERCP group was shorter than that in the LC+LTCBDE group[(4.0±1.7)d vs(6.8±2.3)d,t=-11.076,P<0.01].There was no statistically significant difference in the total incidence rate of postoperative complication between the two groups(7.6%vs 5.3%,χ2=0.566,P=0.452).Further subgroup analysis for the LC+intraoperative ERCP group indicated that,there was no statistically significant difference between the ERCP priority group(n=23)and the LC priority group(n=108)in terms of the success rate of operation,the total operation time,the intraoperative blood loss and the total incidence rate of postoperative complications(P>0.05).Conclusion Both LC+intraoperative ERCP or LC+LTCBDE can treat gallbladder stones combined with non-dilated common bile duct stones safely and effectively.It is recommended to comprehensively evaluate and select the best treatment plan based on the patient's condition,the conditions of the unit,and the surgical ability of the physician.