内镜括约肌切开术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的临床研究

目的探讨内镜括约肌切开术（EST）联合腹腔镜胆囊切除术（LC）治疗胆囊结石合并胆总管结石的临床效果。方法回顾性分析2009年2月～2010年12月行手术治疗的70例胆囊结石合并胆总管结石患者的临床资料,38例行EST＋LC（微创组）,32例行开腹胆囊切除＋胆总管切开取石＋T管引流术（OCHTD）（开腹组）,记录手术情况、术后恢复情况、手术疗效及住院时间。结果微创组手术时间、术中出血量、肛门通气时间及术后住院时间显著低于开腹组,相比较有显著性差异（P〈0.05）。两组均手术成功,微创组术后未发现残余结石,开腹组残余结石率为21.9%,两组相比较有显著性差异（P〈0.05）。微创组并发症发生率显著低于开腹组（P〈0.05）。结论 EST＋LC优于传统开腹手术,其疗效确切、安全可靠,可作为治疗胆囊结石合并胆总管结石的主要方法。

Clinical research of EST and LC treatment for cholecystolithiasis with choledocholithiasis

Objective To investigate the clinical effects of endoscopic sphincterotomy（EST） and laparoscopic cholecystectomy（LC） for cholecystolithiasis with choledocholithiasis.Methods The clinical data of 70 cases with both cholecystolithiasis with choledocholithiasis was retrospectively analyzed from Feb 2009 to Dec 2010,38 cases were given the treatment by EST and LC（minimally invasive group） and 32 cases were given the treatment by OCHTD（laparotomy group）.After treatment the completion of surgery,postoperative recovery,surgical efficacy and hospital stay were observed.Results The operation time,blood loss,ventilation and postoperative hospital stay time after surgery in minimally invasive group were shorter than those in laparotomy group（P0.05）.Both groups were successful surgery,the minimally invasive group was not found residual stones,the rate of residual stones in the laparotomy group was 21.9%,compared the difference was significant（P0.05）.The complication rate of minimally invasive group was significantly lower than the laparotomy group（P0.05）.Conclusion The EST combined with LC is superior to traditional open surgery,which is effective and safe.The EST combined with LC can be used as the primary method for treating of cholecystolithiasis with choledocholithiasis.