腹腔镜胆囊切除联合胆总管探查及内镜括约肌切开治疗胆囊结石并胆总管结石的疗效对比

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查取石术(laparos copiccommon bile duct exploration,LCBDE)与LC联合内镜括约肌切开(endoscopic sphincterotomy,EST)取石术治疗胆囊结石合并胆总管结石的疗效。方法:回顾分析2009年1月至2011年12月247例胆囊结石合并胆总管结石患者的临床资料,其中91例行LC+LCBDE,156例行LC+EST;对比两种术式手术时间、中转开腹率、术后并发症、残石率、住院时间及住院费用等。结果:LC+LCBDE组手术时间短、术后并发症少、住院费用低,但住院时间稍长,两组中转开腹率、残石率差异无统计学意义。结论:LC联合LCBDE及LC联合EST治疗胆囊结石合并胆总管结石安全、可靠。应根据患者具体情况进行个体化治疗,病情允许时LC联合LCBDE可作为首选。

The comparative study of the therapeutic effect of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration and with endoscopic sphincterotomy in the treatment of cholecystolithiasis and choledocholithiasis

Objective: To explore the effects of laparoscopic cholecystectomy(LC) + laparoscopic common bile duct exploration(LCBDE) and LC + endoscopic sphincterotomy(EST) in the treatment of cholecystolithiasis and choledocholithiasis.Methods: The clinical data of patients suffering from cholecystolithiasis and choledocholithiasis from Jan.2009 to Dec.2011 were retrospectively analyzed.LC + LCBDE was performed in 91 cases and LC + EST was performed in 156 cases.Parameters including operative time,rate of conversion to open surgery,postoperative complication,residual bile duct stones incidence,hospital stay and hospitalization cost were comparatively studied.Results: Patients in group of LC + LCBDE had shorter operative time,less postoperative complications and hospitalization cost,while the hospital stay was a little longer.There was not significant difference in conversion rate or residual bile duct stones incidence.Conclusions: Both of LC + LCBDE and LC + EST are safe and reliable to treat patients with cholecystolithiasis and choledocholithiasis.The treatment for patients must be individualized.LC + LCBDE could be the primary choice if possible.