胆囊结石合并胆总管结石两种微创治疗方法的对比分析  

Comparison of two minimally invasive surgeries in the treatment of cholecystolithiasis complicated with choledocholithiasis

作　　者：肖旭[1] 卢潮德[1] 金燕[1] 邱烽 蔡邢峰[1] 

机构地区：[1]南通市第三人民医院,江苏南通226006

出　　处：《腹腔镜外科杂志》2015年第6期451-454,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)+自行脱落胆道J形导管引流、胆管一期缝合与内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)联合LC两种微创术式治疗胆囊结石合并胆总管结石的效果。方法:回顾分析54例胆囊结石合并胆总管结石患者的临床资料,其中观察组28例,采用LC+LCBDE+自行脱落胆道J形导管引流、胆管一期缝合治疗;对照组26例,采用EST+LC治疗。比较两组手术时间、术中出血量、术后肛门恢复排气时间、住院时间、胆漏、胰腺炎等近期并发症及胆管炎、结石复发等远期并发症发生率。结果:两组术中出血量、术后肛门排气时间、住院时间、术后近期并发症发生率相比差异无统计学意义(P>0.05);观察组手术时间长于对照组(P<0.05);术后胆管炎发生率与结石复发率观察组小于对照组,差异有统计学意义(P<0.05)。结论:两种方法均是治疗胆囊结石合并胆总管结石有效的微创治疗方式,LC+LCBDE+自行脱落J形导管引流、胆管一期缝合的远期效果优于EST+LC,临床上应根据具体情况选用。Objective：To explore the efficacies of two minimally invasive surgeries in the treatment of cholecystolithiasis com- plicated with eholedocholithiasis：the laparoscopie cholecystectomy （LC） combined with laparoseopic common bile duct exploration （LCBDE） in which the self-released J-shaped catheter is placed and the primary suture of common bile duct is performed,and the en- doscopic sphineterotomy （EST） with LC. Methods：Clinical data of 54 patients with choleeystolithiasis and eholedoeholithiasis were ret- rospectively analyzed and divided into the observation group （n = 28 ） and the control group （n = 26 ）. The patients in the observation group were treated with LC ＋ LCBDE in which the self-released J-shaped catheter was placed and the primary suture of common bile duct was performed; The patients in the control group were treated with EST ＋ LC. The operation time, intraoperative blood loss, postop- erative anus exhaust time, hospital stay, the occurrence rate of the recent complications such as bile leakage and panereatitis and the oc- currence rate of the long-term complications such as eholangitis and recurrence of calculus were compared between the two groups. Re- stilts：There were no significant differences in intraoperative blood loss, postoperative anus exhaust time, hospital stay and the occurrence rate of postoperative recent complications between the two groups （ P 〉 O. 05 ）. The operation time of the observation group was longer than that of the control group （ P 〉 O. 05 ）. The occurrence rate of eholangitis and the recurrence rate of calculi in the observation group were lower than those in the control group, and the differences were statistically significant （ P 〈 0.05 ）. Conclusions ： Both methods are the effective and minimally invasive for treatment of the cholecystolithiasis complicated with choledocholithiasis. LC ＋ LCBDE,in which the self-released J-shaped catheter is placed and the primary suture of common bile duct is performed, has a bett

关 键 词：胆囊结石病 胆总管结石 腹腔镜检查 胆总管探查 括约肌切开术 内窥镜 胆管一期缝合 

分 类 号：R657.4[医药卫生—外科学]