摘要
目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)与内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)/内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)+LC治疗胆囊结石合并胆总管结石的临床效果。方法:选择2013年12月至2016年12月收治的135例胆囊结石合并胆总管结石患者,分为LC+LCBDE组(n=84)与ERCP/EST+LC组(n=51),对比观察两组术中情况(手术成功率、结石残留率、手术时间、出血量)、术后情况(腹腔引流管留置时间、胃肠功能恢复时间及术后并发症)、住院时间及治疗费用。结果:两组手术成功率、并发症发生率差异无统计学意义;LC+LCBDE组手术时间、术中出血量、术后胃肠功能恢复时间、腹腔引流管放置时间多于ERCP/EST+LC组,但住院时间、住院费用优于ERCP/EST+LC组。结论:治疗胆囊结石合并胆总管结石两种术式均安全、有效,各有优缺点,应根据患者情况、医院设备及医疗水平,结合胆总管结石数量、直径等,慎重选择手术方式。
Objective： To compare the therapeutic efficacy between laparoscopic cholecystectomy（ LC） combined with laparoscopic common bile duct exploration（ LCBDE） and endoscopic retrograde cholangiopancreatography（ ERCP）/endoscopic sphincterotomy（ EST） combined with LC in the treatment of cholecystolithiasis and choledocholithiasis. Methods： From Dec. 2013 to Dec. 2016,135 patients of cholecystolithiasis and choledocholithiasis were divided into LC ＋ LCBDE group（ n = 84） and ERCP/EST ＋ LC group（ n = 51）. The intraoperative indexes（ successful rate of operation,incidence of residual calculi,operation time and blood loss）,postoperative indexes（ the time of peritoneal drainage,gastrointestinal function recovery,postoperative complications）,hospital stay and treatment cost were compared between the two groups. Results： There was no difference in the rate of operation success or the incidence of complications between the two groups. The surgery time,the amount of blood loss during surgery,postoperative gastrointestinal function recovery time,the abdominal cavity drainage time of LC ＋ LCBDE group was more than that of ERCP/EST ＋ LC group,but the hospitalization time and cost of LC ＋ LCBDE group was better than ERCP/EST ＋ LC group. Conclusions： Two kinds of surgical methods are safe and effective,but each has advantages and disadvantages,the clinician should choose the operation method carefully according to the patients＇ own condition,hospital equipment and medical level combined with the quantity and diameter of choledocholithiasis.
作者
易新平
钱巍巍
YI Xin-ping;QIAN Wei-wei(Department of General Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou 545001, China)
出处
《腹腔镜外科杂志》
2018年第3期198-202,共5页
Journal of Laparoscopic Surgery
