两种微创手术治疗胆囊结石合并胆总管结石的临床效果比较  

Comparison of two minimally invasive surgical procedures in treatment of cholecystolithiasis and choledocholithiasis

作　　者：张重捷 陈杰[1] 邹奇[1] 李春生[1] 

机构地区：[1]复旦大学附属上海市浦东医院肝胆外科,201399

出　　处：《临床外科杂志》2016年第11期869-871,共3页Journal of Clinical Surgery

摘　　要：目的探讨两种不同微创手术方式治疗胆囊结石合并胆总管结石的临床效果。方法胆囊结石合并胆总管结石患者83例,其中采用腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)(LC+LCBDE组)治疗胆囊结石合并胆总管结石的患者46例,内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)及乳头括约肌切开取石术(endoscopic sphincterotomy,EST)ERCP/EST+LC(ERCP/EST+LC组)治疗胆囊结石合并胆总管结石的患者37例,比较两组患者的临床治疗情况,包括手术成功率,中转开腹率,术后并发症的发生率,近期结石复发率,住院费用及时间等。结果两组患者的手术成功率(93.5%vs 89.2%),中转开腹率(6.5%vs 5.4%),术后并发症的发生率(8.7%vs 8.1%),近期结石复发率比较(5.2%vs 7.4%),差异均无统计学意义(P>0.05),手术时间,住院时间及治疗费用等比较差异有统计学意义(P<0.05)。结论 LC联合LCBDE与LC联合ERCP/EST对于治疗胆囊结石合并胆总管结石同样有效,LC联合ERCP/EST可缩短手术时间,但在住院时间及治疗费用方面不如LC联合LCBDE,两种微创方式都有其各自的适应证,应根据患者情况制定个体化的治疗方案。Objective To discuss the therapeutic effect of two minimally invasive surgical proce-dures for cholecystolithiasis and choledocholithiasis. Methods Eighty-three cases of cholecystolithiasis and choledocholithiasis were retrospectively analyzed,46 cases underwent laparoscopic cholecystectomy （LC）combined with laparoscopic common bile duct exploration（LCBDE）,37 cases underwent LC com-bined with endoscopic retrograde cholangiopancreatography（ERCP）/ endoscopic sphincterotomy（EST）,to discuss the therapeutic effect including the success rates of operation,the rates of open operation midway, incidence of postoperative complications,the short-term recurrence rate of stones,hospitalization charge and hospital stay. Result There were no statistical differences in the success rate of operation（93. 5% vs 89. 2% ）,the rates of open operation midway（6. 5% vs 5. 4% ）,incidence of postoperative complications （6. 5% vs 5. 4% ）and the short-term recurrence rate of stones（5. 2% vs 7. 4% ）between the two groups （P 〉 0. 05）. There were significant statistical differences in the operation time,hospitalization charge and hospital stay between the two groups（P 〈 0. 05）. Conclusion Both LC ＋ LCBDE and ERCP/ EST ＋ LC are effective therapies for patients with cholecystolithiasis and choledocholithiasis. LC combined with EST can shorten patients’time of the operation,but LC ＋ LCBDE is superior in hospitalization charge and hos-pital stay. Because of different indications of these two minimally invasive surgical procedures,individual-ized treatment programs should be developed according to personal condition.

关 键 词：胆囊结石 胆总管结石 腹腔镜胆总管探查取石术 内镜下逆行胰胆管造影 

分 类 号：R657.4[医药卫生—外科学]