序贯腹腔镜内镜联合手术治疗胆囊合并胆总管结石的临床分析

目的探讨序贯内镜下乳头括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)治疗胆囊合并胆总管结石的疗效。方法将84例胆囊合并胆总管结石患者作为观察对象,随机分为观察组和对照组,每组各42例。观察组采用EST联合LC治疗,对照组采用开腹手术治疗,对比观察两组切口长度、平均出血量、术后使用镇痛药、肛门排气时间、平均住院时间及术后并发症等指标。结果两组患者在平均手术时间上无明显差异(P0.05);观察组在切口长度、出血量、术后使用镇痛药、肠鸣音恢复时间、住院时间上均明显优于对照组,差异有统计学意义(均P0.05);观察组术后并发症发生率为11.90%(5/42),明显低于对照组28.57%(12/42),两组比较差异具有统计学意义(P0.05)。结论序贯EST联合LC治疗胆囊合并胆总管结石较开腹治疗,具有创伤小、出血少、恢复快、并发症发生率低的优势,有较高的临床应用价值。

Clinical analysis of sequential endoscopic-laparoscopic treatment of gallbladder and common bile duct stones

Objective To investigate the clinical effect of endoscopic sphincterotomy （EST） combined with laparoscopic cholecystectomy （LC） in the treatment of gallbladder and common bile duct stones. Methods Eighty-four gallbladder and common bile duct stones cases were selected as observation objects, and were randomly divided into observation group or control group, each group had 42 cases. Observation group was treated with EST combined with LC, while the control group was treated with open operation. Incision length, average amount of bleeding, the use of analgesics after operation, anal exhaust time, hospitalization time, and postoperative complications of the two groups were observed and compared.Results There was no significant difference between the two groups in average operation time （P＞0.05）. The observation group was obviously superior to the control group in incision length, bleeding volume, postoperative analgesic use, recovery time of bowel sound, and hospitalization time, and all the difference was significant （P＜0.05）;and the incidence of complications was 11.90% in the observation group, significantly lower than 28.57% in the control group （P＜0.05）. Conclusion Compared with the conventional open surgery, sequential endoscopic-laparoscopic treatment has the superiority of less trauma, less bleeding, quick recovery, and low complication rate in the treatment of gallbladder and common bile duct stones, indicating its high clinical application value.