三种手术方法治疗胆囊结石并胆总管结石的临床疗效分析

目的 评价三种手术方法治疗胆囊结石并胆总管结石的临床效果.方法 将胆囊结石伴胆总管结石病例随机分为三组:A组:腹腔镜胆囊切除术+经十二指肠乳头切开取石组(LC+EST)(n=20);B组:腹腔镜胆囊切除术+胆总管切开取石(LC+LCBDE)+T管引流组(n=20);C组开腹胆囊切除术+胆总管切开取石+T管引流组(n=20);对比分析三组术后肛门通气时间、禁食时间、术后住院天数、住院费用及术后疼痛率等并发症指标.结果 LC+EST组的术后肛门通气时间、禁食时间、术后疼痛发生率、术后切口脂肪液化率均低于开腹组(P<0.01),术后疼痛发生率、胆漏率低于LC+LCBDE组(P<0.01),但术后血淀粉酶升高率高于LC+LCBDE组和开腹组;三组间术后结石残余率、住院费用、平均住院天数比较无统计学意义(P>0.05).结论 LC+EST术治疗胆囊结石并胆总管结石安全可靠、创伤小、术后恢复快.

Clinical analysis of the therapeutic effect of cholelithiasis and common bile duct by three kind of surgical methods

Objective To evaluate the therapecutic effect of chaolelithiasis and gallstone treated by three surgical methods.Methods Sixty patients with chaolelithiasis and gallstone were randomly divided into three groups with 20 patients in each group,the group A was treated by LC+EST,the group B by LC+LCBDE and the group C by open surgery.The duration of post-operative ileus,duration of hospitalization,the cost for operation,the rate of abdomimal pain and postoperative fat liquefaction of incision and complications were compared among the three groups.Results In laparoscopy combined with ERCP,the duration of post-operative ileus,duration of hospitalization,the rate of abdomimal pain and fat liquefaction were lower than those in open surgery group(P <0.01),the rate of pain and bile leakage w ere lo wer than laparoscop y co mb in ed w ith ch oledo cho sco py gro up(P < 0.0 1),the rate o f hyperamylasemia after operation was higher than group B and C,there were no significant difference of the rates of bile leakage and residual stone among the three groups.Conclusion The combined application of laparoscopy and ERCP in the treatment of chaoledocholithissis with all stones are safe and effective,and with the advantage of less trauma and quick recovery.