腔镜胆总管切开取石与内镜乳头括约肌切开取石术的远期疗效比较

目的 探讨腹腔镜胆总管切开取石术(laparoscopic common bile duct exploration,LCBDE)治疗胆总管结石的优越性.方法 回顾分析2001年6月至2006年6月间,在贵港市人民医院及广西壮族自治区人民医院微创中心行微创手术治疗的胆总管结石的临床资料.按手术方式不同分两组,即LCBDE组和EST(内镜乳头括约肌切开取石术,endoscopic sphincterotomy)组,比较两组的远期疗效.结果 该组225例,其中LCBDE 106例,EST 119例.术后随访1～6年,平均(3.2±0.8)年.LCBDE组结石复发率为3.77%(4/106),反流性胆管炎的发生率为2.83%(3/106),无乳头狭窄;EST组结石复发率为11.76%(14/119),乳头狭窄的发生率为7.56%(9/119),反流性胆管炎的发生率为12.61%(15/119).全组病例无胆管癌发生.术后结石复发率、乳头狭窄和反流性胆管炎的发生率在两组间的差别均有统计学意义.结论 在治疗胆总管结石方面,LCBDE的远期疗效优于EST.

Comparison of long-term efficacy between laparoscopic common bile duct exploration and endoscopic sphincterotomy for common bile duct stone

Objective To investigate the advantage of laparoscopic common bile duct exploration for common bile duct stone. Methods The clinical data of the patients with common bile duct stone receiving minimally invasive surgery in Guigang People's Hospital and Guangxi People's Hospital from June 2001 to June 2006 were retrospectively analyzed. The long-term therapeutic efficacy was compared between the patients undergoing laparoscopie common bile duct exploration(LCBDE group)and those receiving endoscopic sphincterotomy(EST). Results A total of 225 cases were included in this study. Of the patients, 106 received LCBDE and 119 EST. All the patients were followed up for an average of 3.2±0.8 years(1-6 years). In LCBDE group, bile duct recurrent stones was seen in 4 cases(3.77%) and cholangitis in 3(2.83%) and no duodenal papilla stenosis. In EST group, bile duct recurrent stones was seen in 14 cases(11.76%), duodenal papilla stenosis in 9(7.56%) and cholangitis in 15 cases(12.60%). No cholangiocarcinoma was experienced in all the patients. Long-term complications such as bile duct recurrent stones, duodenal papilla stenosis and cholangitis had significant differences between the 2 groups(P<0.05). Conclusion LCBDE is better than EST for common bile duct stone with the advantage of less long-term complications.