腹腔镜内窥镜治疗胆囊结石合并胆总管结石两种术式的临床分析

目的 评价腹腔镜胆囊切除、胆总管探查取石术(LC+LCBDE)与内镜下Oddi括约肌切开、腹腔镜胆囊切除术(EST+LC)两种术式治疗胆囊结石合并胆总管结石的临床效果.方法 回顾总结LC联合治疗胆囊结石合并胆总管结石256例,采用LC+LCBDE术132例、EsT+LC术124例治疗的临床资料,对两组病例的手术成功率、并发症发生率、手术总时间、住院费用、住院日进行对比统计分析.结果 两种术式的手术成功率、并发症发生率、平均住院日无显著性差异(P>0.05),手术总时间、手术费用比较有显著性差异(P<0.01).结论 两种术式各有其适应证和优缺点.胆总管直径<1.0 cm、胆总管中下端结石或老年胆石症病人宜采用EST+LC术式;胆总管直径>1.0 cm的多发性较大结石、尤其是中青年病人应首选LC+LCBDE术式.

Comparison between laparoscopic common bile duct exploration and endoscopic sphincterotomy combined with laparoscopic cholecystectomy in treating cholecystolithiasis with choledocholithiasis

Objective To evaluate the effect of LC+LCBDE and EST+LC in treating the cho-leeystolithiasis with choledocholithiasis. Methods The clinical data of 256 patients treated in our hos-pital were retrospectively analyzed. Of the 256 patients, 132 were treated by LC+LCBDE and 124 by EST combined with LC. The clinical data of the two groups was compared in operation success rate, operation time and cost, complication rate and operative hospital stay. Results There was no statisti-cal difference in the operation success rate, complication rate, operative hospital stay between 2 groups. However, there were significant differences in the operation time and cost between the 2 gruops. Conclusion There are respective indications, advantages and disadvantages in the two groups. EST+LC is the better choice for patients with a CBD<1.0 cm in diameter, stones impacted in the distal CBD, or old age. Otherwise, the better way is LC+LCBDE for patients with a CBD>1. 0 cm in diameter and multiple choledocholithiasis, especially in young and middle-aged people.