胆囊结石合并胆总管结石的临床治疗体会(附566例病例报告)  

作　　者：胡长生[1] 李军 

机构地区：[1]汉中市人民医院普外科,723000 [2]武警陕西总队汉中支队,723000

出　　处：《大家健康（学术版）》2012年第2期2-5,共4页

摘　　要：目的探讨传统开腹胆囊切除术(operation cholecystectomy,OC)+胆总管探查术(common bile duct exploration,CBDE)+T管引流术,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+腹腔镜CBDE与内镜下Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊疾病合并胆总管结石的临床效果及术式选择。方法回顾分析我院1999年5月～2011年10月采用传统OC+CBDE、微创外科技术治疗胆囊结石合并胆总管结石患者566例,其中OC+CBDE组200例,LC+CBDE组88例,EST组278例,比较三组患者的手术时间、术中出血量、术后肠功能恢复时间、术后住院天数、"T"管引流时间、切口长度、切口疼痛程度、住院总费用、并发症发生率、结石消除率等指标。结果开腹组在术中出血量、皮肤切口长度、切口疼痛程度、住院总天数、"T"管引流时间、术后肠功能恢复时间、并发症发生率明显高于LC+CBDE组与EST组(P<0.01),开腹组、LC+CBDE组与EST组手术时间、结石消除率等指标差异无显著性(P>0.05),LC+CBDE组住院总天数、住院总费用、并发症发生率明显少于EST组(P<0.01)。结论三种术式各有其适应证和优缺点,LC+CBDE术式及EST术式为微创手术,开腹胆囊切除术+胆总管探查是补救术式,微创不能完全代替传统开腹术式。Objective To explore the traditional open cholecystectomy(OPeration cholecystectomy,OC) + common bile duct exploration(common bile duct exploration,CBDE) + T tube drainage,laparoscopic cholecystectomy(laparoscopic cholecystectomy,LC) + laparoscopic gallbladder Mirror Explorer duct exploration(common bile duct exploration,CBDE) Oddi with endoscopic sphincterotomy(endoscopic sphincterotomy,EST) LC combined treatment of gallbladder and biliary stone disease,the clinical efficacy and surgical options.Methods Retrospective analysis of our hospital in May 1999 ~ December 2010 in our hospital using the traditional open cholecystectomy + common bile duct exploration,minimally invasive surgical treatment of gallbladder stones and biliary stones were 566 patients,of which OC + CBDE200 cases,LC + CBDE group of 88 patients,EST group of 278 patients,comparing the three groups in operative time,blood loss,postoperative intestinal function recovery time,postoperative hospital stay,'T'tube drainage time,incision length,incision pain level,the total cost of hospitalization,complication rate,stone free rate and other indicators.Results The open group on blood loss,incision length,incision pain,total hospital days,'T' tube drainage duration,postoperative intestinal function recovery time,complications were significantly higher than that of group LC + CBDE EST group(P<0.01),laparotomy group,LC + CBDE group and the EST operation time,stone free rate and other indicators showed no significant(P>0.05),LC + CBDE group total bed days,hospital costs,complications were significantly less than the EST group(P<0.01).Conclusion The three surgical methods have their own indications,advantages and disadvantages,LC + CBDE EST surgical and surgical for the minimally invasive surgery,open cholecystectomy + common bile duct exploration is a surgical remedy,can not completely replace the traditional invasive open abdominal surgical procedures.

关 键 词：胆总管结石 传统开腹术式 腹腔镜术 胆总管探查术 括约肌切开术 内窥镜检查 

分 类 号：R657.4[医药卫生—外科学]