腹腔镜胆总管探查联合胆囊切除术治疗胆总管结石并胆囊结石的临床研究

目的：探讨腹腔镜胆总管探查联合胆囊切除术治疗胆总管结石并胆囊结石的临床价值。方法对2010年1月至2013年4月期间我院收治的84例胆总管结石合并胆囊结石患者进行微创治疗，依据治疗方法的不同分为两组，采用腹腔镜胆总管探查取石术（LCBDE）＋腹腔镜胆囊切除术（LC）组和内镜十二指肠括约肌切开术（EST）＋LC组，每组各42例。比较两组的手术治疗成功率、残余结石率、手术时间、术中出血量、术后并发症发生率、胃肠功能恢复时间、住院时间和费用等指标，并对LCBDE＋LC亚组术式的选择进行回归分析。结果两组手术成功率LCBDE＋LC组为97.62%，EST＋LC组为95.24%；两组残石率LCBDE＋LC组为2.38%，EST＋LC组为7.14%，差异均无统计学意义（P〉0.05）。LCBDE＋LC组术中出血量、手术时间和并发症数均明显少于EST＋LC组，差异具有统计学意义（P〈0.05）。LCBDE＋LC组患者在术后镇痛药物应用率、术后平均体温、术后胃肠功能恢复时间、住院时间和住院费用等均明显低于EST＋LC组，差异具有统计学意义（P〈0.05）。Logistic回归分析显示， LCBDE＋LC组内一期缝合与胆总管内径、胆囊结石数目和胆总管下端通畅存在明显的独立相关性，差异具有统计学意义（P〈0.05）。结论 LCBDE＋LC对于胆囊结石合并胆总管结石疗效肯定，并发症低，患者负担轻，针对相关适合患者可以采取对胆总管一期缝合。

Clinical study of laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treatment of choledocholithiasis and cholecystolithiasis

Objective To compare the effects of laparoscopic common bile duct exploration （LCBDE） com-bined with laparoscopic cholecystectomy （LC） in patients with choledocholithiasis combined with cholecystolithiasis. Methods From January 2010 to April 2013, 84 patients with cholecystocholedocholithiasis were treated either by LCBDE＋LC （n=42） or LC＋endoscopic sphincterotomy （EST, n=42）. The success rate of treatment, complications, the rate of retained bile duct stones, time of surgery, amount of bleeding, recovery of gastrointestinal function and hospital-stay were retrospectively analyzed. The selection of surgical procedures in LCBDE＋LC subgroup was analyzed by logistic regression. Results The operative success rate and retained bile duct stones rate in LCBDE＋LC group were 97.62%and 2.38%respectively, which in EST＋LC group were 95.24%and 7.14%respectively, and there were no sig-nificant differences between the two groups （P〉0.05）. The incidence of postoperative complication time of surgery, amount of bleeding, length of hospital stay, cost of hospital stay, average temperature of postoperative, gastrointestinal function after surgery for postoperative and ratio of postoperative analgesia in LCBDE＋LC group were significantly less than those in EST＋LC group （P〈0.05）. Logistic regression analysis showed that the inner diameter of common bile duct, number of gallbladder stones and bile duct patency were related factors with primary suture in LCBDE ＋LC group. Conclusion Because of the advantages of less trauma, quicker recovery, fewer complications and shorter length of hospitalization time, LCBDE＋LC could be recommended to be the main method for cholecystocholedocholithiasis.