内镜腹腔镜序贯治疗胆囊并胆总管结石  

ANALYSIS AND CLINICAL EVALNATION OF SEQUENCE EST CONBINED WITH LC FOR THE TREATMENT OF CHOLECYSTOLITHIASIS AND CHOLEDOCHOLITHIASIS

作　　者：雷海录[1] 周毅[1] 付京[1] 于颖[1] 雷莹[1] 张鹏[1] 延伟[1] 

机构地区：[1]解放军第451医院,西安710054

出　　处：《肝胆外科杂志》2009年第2期113-115,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨内镜下乳头括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)治疗胆囊并胆总管结石的效果及顺序的选择。方法回顾性分析468例胆囊并胆总管结石分别采用LC术前EST(306例)和LC术后EST(162例)治疗的临床资料,对结石清除率、并发症发生率、中转开腹率和住院天数、手术间隔天数指标进行比较。结果LC术前EST组结石清除率(97%)并发症发生率(6.2%)中转开腹率(5.3%)手术间隔天数(5天)住院时间(10天),LC术后EST组结石清除率(97.5%)并发症清除率(14.2%)中转开腹率(4.9%)手术间隔天数(5天)住院天数(13天),两组病例在结石清除率、手术间隔天数、中转开腹率和住院时间等方面无明显差异,在并发症的发生率有显著差异。结论EST联合LC是治疗胆囊并胆总管结石安全合理的方法,序惯顺序LC术前行EST,可有效减少手术并发症。LC术后EST,对于LC术后胆道残留结石EST又是其必要的补充。Objective To study the effects and program choice of combination of endoscopic spinecterotomy（EST） and laparoscopic cholecystectomy （LC） for the treatment of cholecystolithiasis and choledocholithiasis. Methods From analysis of many cases, 306 patients with choleeystolithiasis and choledocholithiasis were treated by EST combined with before LC, and 162 cases were tread by EST with after LC. The duct-clearance rates, complication rate, conversion rate, hospital length of stay and Operation duration days in the two groups were evaluted retrospectively. Results The duct-clearance rate was 97% in the EST before LC group compared with 97.5% in the EST after LC group. The complication rate was 6.2% in the EST before LC group compared with 14.2% in the EST after LC group. The conversion rate was 5.3% in the EST before LC group compared with 4. 9% in the EST after LC group. The operation duration days was 5 days in the EST before LC group compared with 5 days in the EST after LC group. Hospital length of stay was 10 days in the EST before LC group compared with 13 days in the EST after LC group. Conclusion EST combined with LC is feasible methods for treatment of cholecystolithiasis and choledocholithiasis. The operation EST before LC can reduce complication of opeation effectively. The operation EST after LC is necessary for LC.

关 键 词：胆总管结石 内镜乳头肌括约肌切开取石术 腹腔镜胆囊切除术 

分 类 号：R657.3[医药卫生—外科学]