ERCP/EST联合LC治疗胆总管结石合并胆囊结石的临床疗效

目的 探讨内镜逆行胰胆管造影术（endoscopic retrograde pancreatic angiography，ERCP）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）治疗胆总管结石合并胆囊结石的临床疗效。方法 选择笔者医院自2011年10月～2015年5月共收治112例胆总管结石合并胆囊结石的患者，其中73例行ERCP/EST+LC（观察组），39例行外科开腹手术治疗（对照组）。比较两组手术的成功率、手术一般情况、术后并发症发生率、术后结石残留率及复发率等指标。结果 观察组与对照组手术成功率比较，差异无统计学意义（94.5% vs 97.4%，P >0.05）。观察组患者肛门排气时间、住院时间、禁食天数均显著小于对照组（2.32±1.04天vs 3.25±1.21天，11.05±3.10天vs 18.15±6.84天，2.17±0.52天vs 3.56±0.59天），差异有统计学意义（P<0.05）；观察组并发症发生率显著低于对照组（7.50% vs 27.50%），差异有统计学意义（P<0.05）；观察组患者结石残留率及复发率均显著低于对照组（1.37% vs 5.13%，9.59% vs 15.38%），差异有统计学意义（P<0.05）。结论 ERCP/EST联合LC治疗胆总管结石合并胆囊结石具有良好的疗效，与传统开腹手术相比，具有创伤小、恢复快、术后并发症少、复发率低的优势。

Clinical Effects of ERCP/EST Combined LC in the Treatment of Gallbladder Stones with Choledocholithiasis

Objective To explore the clinical effects of endoscopic retrograde pancreatic angiography(ERCP) combined laparoscopic cholecystectomy(LC) in the treatment of gallbladder stones with common bile duct calculi. Methods From oct 2011 to may 2015,112 patients with cholecystocholithiasis underwent either ERCP+LC(observation group, n=73) or coventional surgery(control group, n=39). The treatment success rate, the general status of patients, complications, and the rates of residual stones, and relapse were compared for two groups. Results There was no significant difference in the operative success rate between the two group(94.5% vs 97.4%,P >0.05).The operative time, time to first exhaust, hospitalization time and time to first food for the observation group were significantly better than those for the control group(2.32±1.04days vs 3.25±1.21days,11.05±3.10days vs 18.15±6.84days,2.17±0.52days vs 3.56±0.59days,P<0.05). The rate of complications for the observation group was significationly lower than for the control group(7.50% vs 27.50%,P<0.05). The rates of residual stones, and relapse for the observation group were also significantly lower than those for the control group(1.37% vs 5.13%,9.59% vs 15.38%,P<0.05). Conclusion ERCP/EST combined LC is superior to conventional surgery in the treatment of gallbladder stones with choledocholithiasis with regard to minimal surgical trauma, quicker recovery, and lower rates of complication,relapse.