经内镜乳头括约肌切开与开腹胆总管切开取石术治疗胆总管结石患者的疗效及安全性  

Efficacy and safety of endoscopic and laparotomy in the treatment of patients with choledocholithiasis

作　　者：殷德荣[1] 韩鑫[2] 吴佩宏 徐鸿涛[2] 

机构地区：[1]陕西省汉中市人民医院消化科,723000 [2]陕西省汉中市人民医院普外科,723000

出　　处：《疑难病杂志》2016年第11期1135-1138,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨胆总管结石患者行经内镜乳头括约肌切开（EST）与开腹胆总管切开取石术（OCT）的效果及安全性。方法选取2010年3月—2015年3月陕西省汉中市人民医院收治择期手术的98例胆总管结石患者作为研究对象。按照不同手术方式分为EST＇组49例和OCT组49例,OCT组行传统开腹胆总管切开探查取石术,EST组行内镜逆行胰胆管造影联合EST取石。比较2组患者围手术情况、结石清除情况及并发症发生情况,同时采用胃肠生活质量量表（GIQLI）评定2组患者生活质量;随访12-18个月观察并发症发生情况。结果 EST组手术时间、住院时间、术中出血量、腹痛持续时间、肠鸣音恢复时间均明显短/少于OCT组,差异有统计学意义（t=36.115、10.356、88.928、18.198、34.946,P均〈0.01）;OCT组结石清除率略高于EST组,但差异无统计学意义（87.8%vs93.9%,t=2.238,P〉0.05）;EST组消化道出血、胆道黏膜出血、切口感染显著低于OCT组,高淀粉酶血症明显高于OCT组（χ^2=6.292、6.292、10.748、5.869,P均〈0.05）,而肺部感染、反流性食管炎无明显差异（χ^2=2.163、0.332,P均〉0.05）;EST组在用药3个月后生活质量总评分显著高于OCT‘组,差异具有统计学意义（t=4.638,P〈0.01）;随访12-18个月,2组患者均未发生胆管狭窄、胆系感染、胆漏及残留结石。结论胆总管结石患者行EST手术方式较传统OCT手术创伤小,术中出血量少,有利患者的恢复,符合外科微创的理念,是一种安全可靠的手术选择方式,值得临床推广应用。Objective To investigate the efficacy and safety of endoscopic papillary sphincter incision（EST） and open common bile duct（OCT） in patients with common bile duct stones.Methods Ninety-eight cases of patients with choledocholithiasis were selected,which were treated in our hospital from March 2013 to March 2015,and were divided into EST group（49 cases） and OCT group（49 cases）.The patients of OCT group were treated with traditional open choledochotomy stone surgery,and the patients of EST group were treated with EST joint EST stone extraction.Compare the surgery,the stone removals,complications,quality of life and follow up of two groups.Results EST group,operation time,hospitalization time,intra-operative bleeding,duration of abdominal pain,bowel sound recover） time were significantly shorter/ less than the OCT group,the difference was statistically significant（t=36.115,t=10.356,t=88.928,t=18.198,t=34.946,P〈0.01）;group OCT,the stone clearance rate was slightly higher than that of EST group,but no statistical significance the difference（87.8%vs.93.9%,t=2.238,P〉0.05）;group EST＇s gastrointestinal bleeding,biliary tract bleeding,wound infection was significantly lower than OCT group,hyperamylasemia was significantly higher than OCT group（χ^2=6.292,χ^2=6.292,χ^2= 10.748,χ^2=5.869,P〈0.05）,but there was no significant difference in lung infection,reflux esophagitis（χ^2=2.163,χ^2=0.332,P〈0.05）;EST group in 3 months after total quality of life score was significantly higher than that of OCT group,the difference was statistically significant（t=4.638,P〈0.01）;followed up for 12 to 18 months,2 groups of patients were not bile duct stricture,biliary infection,bile leakage and residual stone.Conclusion Common bile duct calculi underwent EST surgery compared with traditional open stone surgery,less trauma,less bleeding,beneficial to the recovery of patients,in line with the concept of minimally invasive surgery,surgery is a safe and reliable choice,it is worthy of clinical a

关 键 词：内镜乳头括约肌切开取石术 开腹胆总管切开取石术 胆总管结石 安全性 生活质量 

分 类 号：R657.4[医药卫生—外科学]