两种微创术式治疗胆囊结石合并胆总管结石的效果比较  

Clinical effects of two surgical procedures in treatment of gallstones complicated by common bile duct stones:a comparative analysis

作　　者：陈高飞[1] 芦小龙[1] 李剑辉[1] 吕宗峻 景东帅 郑建忠[2] 

机构地区：[1]新疆医科大学,乌鲁木齐830011 [2]新疆医科大学第二附属医院普通外科,乌鲁木齐830063

出　　处：《临床肝胆病杂志》2017年第2期300-303,共4页Journal of Clinical Hepatology

摘　　要：目的比较分析腹腔镜胆总管探查术(LCBDE)联合腹腔镜胆囊切除术(LC)与经内镜逆行胰胆管造影(ERCP)/内镜下Oddi括约肌切开术(EST)联合LC治疗胆囊结石合并胆总管结石的疗效。方法回顾性分析新疆医科大学第二附属医院2013年6月-2016年6月进行微创手术治疗胆囊结石合并胆总管结石的患者56例,其中24例行LCBDE+LC治疗,32例行ERCP/EST+LC治疗,对两种治疗方法的手术成功率、手术时间、术后肛门排气时间、住院时间、住院费用、术后并发症等临床资料进行比较。计量资料2组间比较采用t检验。结果 LCBDE+LC组手术成功22例(91.67%),中转开腹2例(8.33%),术后并发胆漏2例;ERCP/EST+LC组手术成功30例(93.75%),中转开腹2例(6.25%),术后并发胰腺炎6例、出血1例。2组术后胰腺炎的发生率比较差异有统计学意义(χ~2=5.040,P=0.035)。LCBDE+LC组在手术时间、住院时间、住院费用方面低于ERCP/EST+LC组,且差异有统计学意义(t值分别为-5.818、-5.393、-3.566,P值均<0.05)。结论 LCBDE+LC和ERCP/EST+LC均是治疗胆囊结石合并胆总管结石的有效微创疗法,但要根据患者的不同情况选择合适的治疗方式。Objective To investigate the clinical effects of laparoscopic common bile duct exploration（ LCBDE） combined with laparoscopic cholecystectomy（ LC） versus endoscopic retrograde cholangiopancreatography（ ERCP） / endoscopic sphincterotomy（ EST） combined with LC in the treatment of gallstones complicated by common bile duct stones.Methods A retrospective analysis was performed for the clinical data of56 patients with gallstones complicated by common bile duct stones who underwent minimally invasive surgeries in The Second Affiliated Hospital of Xinjiang Medical University from June 2013 to June 2016.Among these patients,24 were treated by LCBDE ＋ LC and 32 were treated by ERCP / EST ＋ LC.The clinical data including success rate of operation,time of operation,time to passage of gas by anus,length of hospital stay,hospital costs,and postoperative complications were compared between these two groups.The t- test was used for comparison of continuous data between groups.Results Of all patients in the LCBDE ＋ LC group,22（ 91.67%） underwent a successful surgery and 2（ 8.33%）were converted to laparotomy;2 patients experienced bile leakage after surgery.Of all patients in the ERCP / EST ＋ LC group,30（ 93.75%）underwent a successful surgery and 2（ 6.25%） were converted to laparotomy;6 patients experienced pancreatitis and 1 experienced bleeding after surgery.There were significant differences in incidence of pancreatitis between groups.Compared with the ERCP / EST ＋ LC group,the LCBDE ＋ LC group had significantly shorter time of operation and length of hospital stay and significantly lower hospital costs（ t =- 5.818,- 5.393,and- 3.566,all P 0.05）.Conclusion Both LCBDE ＋ LC and ERCP / EST ＋ LC are effective minimally invasive therapies for gallstones complicated by common bile duct stones,but the treatment method should be selected based on patients＇ condition.

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 括约肌切开术 内窥镜 

分 类 号：R657.4[医药卫生—外科学]