| 两种手术治疗胆囊结石并胆总管结石的疗效比较 |
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| 引用本文： | 连建安,伍登海,马红梅,季超超,姜斌骅.两种手术治疗胆囊结石并胆总管结石的疗效比较[J].中华全科医学,2018,16(3):367-370. |
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| 作者姓名： | 连建安 伍登海 马红梅 季超超 姜斌骅 |
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| 作者单位： | 浙江中医药大学附属第二医院肝胆外科, 浙江 杭州 310005 |
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| 基金项目： | 浙江省自然科学基金(LY14H160038) |
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| 摘 要： | 目的 回顾性分析比较腹腔镜胆囊切除术+腹腔镜胆总管切开胆道镜探查取石术(LC+LCBDE)与内镜逆行胰胆管造影/内镜十二指肠乳头括约肌切开取石术+腹腔镜胆囊切除术(ERCP/EST+LC)治疗胆囊结石并胆总管结石的临床疗效。 方法 选取2011年2月-2016年2月间浙江中医药大学附属第二医院治疗的胆囊结石并胆总管结石患者300例,根据对患者采取手术方案的不同,将患者分为LC+LCBDE组与ERCP/EST+LC组,每组150例。比较2组患者临床资料、治疗效果、术后并发症发生率及肝功能等相关指标情况。 结果 2组患者在手术成功率、中转开腹率方面比较差异无统计学意义(均P>0.05),但LC+LCBDE组在手术时间、住院时间及手术费用等方面明显低于ERCP/EST+LC组(均P<0.05)。2组患者术后1 d胆红素、丙氨酸转氨酶、天门冬氨酸转氨酶升高,术后3 d各指标均恢复至正常。术后并发症发生率LC+LCBDE组6.67%,ERCP/EST+LC组为8.67%,2组差异无统计学意义(P>0.05)。2组患者出院后短期随访结石复发率差异无统计学意义(P>0.05)。 结论 LC+LCBDE与ERCP/EST+LC均为治疗胆囊结石并胆总管结石的术式,其中LC+LCBDE在手术时间、住院时间及手术费用等方面更具优势,但临床工作中仍需遵循个性化原则,根据患者的实际病情与医院条件灵活选择手术方式。
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| 关 键 词： | 胆囊结石并胆总管结石 腹腔镜胆囊切除术 腹腔镜胆总管切开胆道镜探查取石术 内镜逆行胰胆管造影 括约肌切开取石术 |
| 收稿时间： | 2017-09-26 |
Effect comparison of two surgeries on gallbladder stones and common bile duct stone |
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| Affiliation: | Hepatobiliary Surgery Department, the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310005, China |
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| Abstract: | Objective To retrospectively analyze the effect of laparoscopic cholecystectomy combined with laparoscopic choledocholithotomy on choledochoscopy lithotomy (LC + LCBDE) and endoscopic retrograde cholangiopancreatography/endoscopic duodenal sphincterotomy+Laparoscopic cholecystectomy (ERCP/EST+LC) on treatment of gallbladder stones and common bile duct stones. Methods Three hundred patients with gallstone and common bile duct stones treated in our hospital from February, 2011 to February, 2016 were enrolled in this study. According to surgical methods, patients were divided into LC + LCBDE group and ERCP/EST+LC group, each group 150 cases. The clinical data, treatment effect, postoperative complications and liver function and other related indicators of two groups were compared. Results There was no significant difference between two groups on operation success rate and laparotomy rate (P>0.05). The operation time, hospital stay and operation cost of LC + LCBDE group were significantly lower than those of ERCP/EST+LC group (P<0.05). The direct bilirubin, aspartate aminotransferase and alanine aminotransferase levels at 1 day after surgery were increased, but returned to normal levels at the 3rd day after operation. The postoperative complication rate of LC + LCBDE group was 6.67%, and postoperative complication rate of ERCP/EST+LC group was 8.67%, with no statistical significance (P>0.05). There was no significant difference in stone recurrence between two groups after discharge (P>0.05). Conclusion LC + LCBDE and ERCP/EST+LC were safe and effective methods on treatment gallbladder stones and common bile duct stones. LC + LCBDE had more advantages in operation time, hospitalization time and operation cost. In clinical work, surgical method should be selected based on the individuality principle, actual condition and hospital conditions. |
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