腹腔镜联合内镜治疗胆囊结石合并胆总管结石的临床疗效  

Clinical effects of laparoscopy combined endoscopy for treating cholecystolithiasis complicating choledocholithiasis

作　　者：陈高飞[1] 芦小龙[1] 李亮[1] 李建刚[1] 李剑辉[1] 郑建忠[1] 

机构地区：[1]新疆医科大学第二附属医院普通外科,新疆乌鲁木齐830063

出　　处：《现代医药卫生》2016年第21期3298-3300,共3页Journal of Modern Medicine & Health

摘　　要：目的比较内镜下逆行胰胆管造影(ERCP)、内镜下oddi括约肌切开取石术(EST)联合腹腔镜胆囊切除术(LC)与传统开腹手术治疗胆囊结石合并胆总管结石疗效。方法回顾性分析该院2013年6月至2016年6月进行手术治疗胆囊结石合并胆总管结石的患者106例,将其分为微创组(61例)和传统组(45例)。微创组行ERCP/EST联合LC手术;传统组行开腹切除胆囊合并胆总管切开取石术。对比两组的临床疗效及并发症发生情况。结果微创组一次性结石清除率为96.72%(59/61),传统组一次性结石清除率为93.33%(42/45),两组比较,差异无统计学意义(P>0.05)。微创组手术时间、术中出血量、术后肛门排气时间、总住院时间均少于传统组,而住院总费用高于传统组,差异均有统计学意义(P<0.05)。微创组术后急性胰腺炎的发生率高于传统组,差异有统计学意义(P<0.05),而术后胆瘘、切口感染发生率与传统组比较,差异无统计学意义(P>0.05)。结论腹腔镜联合ERCP/EST技术可安全用于胆囊结石合并胆总管结石的治疗,该方法创伤小、恢复快,患者住院时间缩短,值得推广使用。Objective To compare the therapeutic effects between endoscopic retrograde cholangiopan creatography（ERCP）/endoscopic sphincterotomy（EST）combined with laparoscopic cholecystectomy（LC） versus the traditional laparotomy for treating cholecystolithiasis complicating choledocholithiasis. Methods One hundred and six patients with cholecystolithiasis and choledocholithiasis operatively treated in our hospital from June of 2013 to June of 2016 were retrospectively analyzed. The cases were divided into the minimally invasive group（61 cases） and conventional group（45 cases）. The minimally invasive group was performed the operation of ERCP/EST ＋LC,while the traditional group was performed the open cholecystectomy and choledocholithotomy. The clinical effects and complications were compared between the two groups. Results The once calculi clearance rate was 96.72%（59/61） in the minimally invasive group and 93.33%（42/45） in the conventional group,and the difference was not statistically significant（P〈0.05）. The operation time,intraoperative blood loss,postoperative anal exhaust time and total hospitalization time in the minimally invasive group were less than those in the conventional group,but the hospitalization costs were higher than that in the control group,the differences were statistically significant（P〈0.05）. The occurrence rate of postoperative acute pancreatitis in the minimally invasive group was higher than that in the conventional group with statistical difference（P〈0.05）,but occurrence rates of postoperative biliary fistula and infection had no statistical difference between the two groups（P〈0.05）.Conclusion The operation of ERCP/EST＋LC can be safely used in treating cholecystolithiasis complicating choledocholithiasis,which has the advantages of small trauma,speedy recovery and shorter duration of hospitalization,and is worth for promotion and application.

关 键 词：胆囊结石病 胆总管结石 胆囊切除术 腹腔镜 胰胆管造影术 内窥镜逆行 外科手术 

分 类 号：R657.4[医药卫生—外科学]