微创治疗胆总管结石的术式选择  

Minimally invasive surgical treatment of common bile duct stones

作　　者：陈小勋[1] 李强辉[1] 张兆明[1] 周永淳[1] 郑逸川[1] 韦振轩[1] 黄克伟[1] 

机构地区：[1]广西贵港市人民医院普通外科,广西贵港537100

出　　处：《中国普通外科杂志》2010年第10期1135-1138,共4页China Journal of General Surgery

摘　　要：目的探讨不同条件下胆总管结石(CBDS)的微创手术方案。方法分析近9年间我科治疗的203例CBDS患者的临床资料。据手术方式不同分组:十二指肠镜下乳头气囊扩张取石术(EPBD)组(22例)、十二指肠镜下乳头括约肌切开取石术(EST)组(105例)、腹腔镜胆总管切开取石术(LCBDE)组(76例)。结果 3组的手术成功率、近期并发症发生率、残石率比较差异无统计学意义(P>0.05)。手术时间3组比较差异有统计学意义(P=0.000),LCBDE组最短;住院时间3组间差异有统计学意义(P=0.000),EPBD组最短。随访期间结石复发率、反流性胆管炎及乳头狭窄发生率3组间差异有统计学意义(P<0.05),LCBDE组与EPBD组相当,EST组最差。结论有适应证的CBDS患者首选EPBD,失败或无适应证者选择LCBDE,EST仅适用于有严格适应证者。Objective To explore the plan of minimally invasive operation methods for managing the common bile duct stones （CBDS） according to different conditions.Methods The clinical data of 203 patients with CBDS treated in our department during last 9 years were analyzed retrospectively.According to the different type of operation,the patients were devided into：Endoscopic papillary balloon dilatation （EPBD） group,including 22 cases,endoscopic sphincterotomy （EST） group,including 105 cases; and laparoscopic common bile duct exploration （LCBDE） group,including 76 cases.Results Statistically significant difference was not found among the three groups in success rate of surgery,recent complications rate or residual stone rate （P0.05）.The operation time was significantly different statistically （P=0.000）,and the shortest was LCBDE group.Hospital stay was statistically significantly different （P=0.000）,and the shortest was EPBD group.Stone recurrence,reflux cholangitis and papillary stricture rate were statistically different（P0.05）,they were equivalent in LCBDE group and EPBD group,and worst in EST group.Conclusions EPBD should be carried out as the first choice for patients with CBDS.If EPBD fails or there is no indication for EPBD,LCBDE can be selected,while EST should be applied only to suitable candidates with strict indications.

关 键 词：胆总管结石 腹腔镜 十二指肠镜 术后并发症 术式选择 

分 类 号：R657.42[医药卫生—外科学]