摘要
目的评价三种术式治疗胆囊结石继发肝外胆管结石的应用价值。方法将2012年1月至2016年1月内蒙古医科大学附属医院收治的157例胆囊结石继发肝外胆管结石患者，按术式不同分为3组：腹腔镜胆囊切除＋胆总管探查术（LC-LCBDE组）（49例）、内镜下逆行胰胆管造影＋腹腔镜胆囊切除术（ERCP-LC组）（51例）及开腹胆囊切除＋胆总管探查取石术（OC-OCBDE组）（57例）。比较3组患者术中、术后及随访的情况。结果3组患者：术中出血量[LC-LCBDE组：（18．16±3．88）ml、ERCP-LC组：（17．37±3．79）ml、OC—OCBDE组：（60．39±8．73）ml，P=0．000]、手术时间[LC-LCBDE组（118．27±8．89）min、ERCP—LC组（124．27±9．48）min、OC—OCBDE组（94．25±6．39）min，P=0．000]、手术成功率（LC-LCBDE组89．20％、ERCP-LC组86．93％、OC-OCBDE组100％，P=0．02）、肛门排气时间[LC-LCBDE组（42．4±3．4）h、ERCP—LC组（43．6±3．3）h、OC-OCBDE组（53．9±4．8）h，P=0．000]、住院总费用[LC．LCBDE组（1．86±0．13）万元、ERCP．LC组（3．33±0．20）万元、OC-OCBDE组（1．38±0．19）万元，P=0．000]、血清淀粉酶升高（LC—LCBDE组1例、ERCP-LC组14例、OC-OCBDE组2例，P〈0．01）及术后住院时间（LC-LCBDE组5．20±0．77、ERCP—LC组4．85±0．51、OC-OCBDE组8．55±0．71d，P=0．000）差异有统计学意义；术后胆瘘（LC．LCBDE组2例、ERCP．LC组0例、OC-OCBDE组2例）及结石残留率（LC—LCBDE组4．08％、ERCP—LC组5．88％、OC-OCBDE组3．50％）差异无统计学意义。结论LC—LCBDE保护了Oddis括约肌，ERCP-LC维持了胆总管的完整性，OC．OCBDE可以作为前两种术式的补救措施，但均无绝对优势。
Objective To investigate the clinical efficieneies of the three surgical patterns in the treatment of cholecysto-choledocholithiasis （CCL）. Methods A total of 157 patients with CCL, during the period from Janury 2012 to Janury 2016 at the Affiliated Hospital of Inner Mongolia Medical University, were divided into three groups according to surgical patterns ： LC-LCBDE Group （ laparoscopic cholecystectomy ＋ laparoseopic common bile duct exploration, n=49 ）, ERCP-LC Group （endoscopic retrograde choiangiopancreatography ＋ laparoseopic cholecystectomy, n = 51 ） and OC-OCBDE Group （open eholecystectomy ＋ open common bile duct exploration, n = 57 ）. Simultaneously, the intraoperative, postoperative and follow-up results of all the patients were compared. Results There were significantly differences among three groups in intraoperative blood loss [ LC-LCBDE Group： （18.16 ± 3.88） ml, ERCP- LC Group： （ 17. 37 ±3.79） ml, and OC-OCBDE Group： （60. 39 ±8.73） ml, P =0. 000] , operation time [ LC-LCBDE Group： （118.27 ± 8.89） min, ERCP-LC Group： （ 124. 27 ±9.48 ） min, and OC-OCBDE Group ： （94. 25 ± 6. 39 ） min, P = 0. 000 ] , surgical successful rate （ LC-LCBDE Group 89.20% , ERCP- LC Group 86. 93% , and OC-OCBDE Group 100%, P = 0. 02）, intestine function recovery [ LC-LCBDE Group （42. 35±3.44） h, ERCP-LC Group （43.61 ±3.34） h, and OC-OCBDE Group （53.86 ±4. 76） h, P = 0. 000 ] , hospitalization cost [ LC-LCBDE Group （ 18 600 ±1300 ） yuan, ERCP-LC Group （ 33 300 ±2 000） yuan, and OC-OCBDE Group （ 13 800 ±1 900） yuan, P= 0.0003, serum amylase elevation （LC-LCBDE Group 1 case, ERCP-LC Group 14 cases, and OC-OCBDE Group 2 cases, P 〈 0. 01 ） and postoperative hospital stay （LC-LCBDE Group 5.20 ± 0. 77 d, ERCP-LC Group 4. 85 ±0. 51 d, and OC-OCBDE Group 8.55 ± 0.71 d, P= 0.000） . There were no differences among three groups in postoperative biliary leakage （ LC-LCBDE Group 2 cases, ERCP-LC Group 0 case, and OC-OCBDE Group 2 cases） and residual bile duct stone rate （LC-LCBDE Group 4. 08%, ERCP-LC Group 5.88%, and OC-OCBDE Group 3.50% ）. Conclusion All three types of surgical pattern are both efficacious and safe in the treatment of CCL. But no single pattern has absolute advantage over the other two. LC-LCBDE could preserve the function of Oddis sphincter, ERCP-LC could retain the integrity of common bile duct （CBD） , and OC-OCBDE could serve as remedial measure for LC-LCBDE and ERCP-LC.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第4期276-279,共4页
National Medical Journal of China
基金
内蒙古自然科学基金[2016MS（LH）0809]
关键词
胆囊结石
肝外胆管结石
外科手术
Cholecystolithiasis
Calculusofextrahepaticbileduct
Surgical procedures, operative
