腹腔镜胆总管探查取石与内镜ERCP/EST联合LC治疗胆囊疾病合并胆总管结石的临床对比研究

【目的】评价腹腔镜胆总管探查取石术(LCBDE)与内镜逆行胆管造影、括约肌切开取石术(ER CP/EST)联合腹腔镜胆囊切除术(LC)治疗胆囊疾病合并胆总管结石的临床效果,探讨胆石症的微创外科治疗策略。【方法】回顾性分析152例胆囊疾病合并胆总管结石病人分别采用LC LCBDE术(68例)、内镜EST联合LC术(84例)治疗的临床资料, 进行胆总管内径、结石大小、手术时间、手术费用、并发症发生率、术后住院日等方面的统计学对比分析。【结果】两种术式的术后住院日差异无显著性(P>0. 05),手术时间、手术费用、并发症发生率等方面比较差异有显著性(P<0. 01 ), 且两者的胆总管内径、结石大小相比较有差别。【结论】胆总管直径小于1. 0cm,尤其胆总管下端结石嵌顿时宜采用内镜、腹腔镜联合手术治疗;胆总管直径大于1. 0cm或多发结石,尤其并存二级支肝管结石者(无胆管狭窄),腹腔镜下一期手术LC LCBDE是治疗胆囊疾病合并胆总管结石的最佳选择。

The Comparative Analysis Between Laparoscopic Common Bile Duct Exploration and Endoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy in Treating Gallbladder Diseases with Choledocholithiasis

To evaluate the effects of laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreaticography and endoscopic sphincterotomy (ERCP/EST) combined with laparoscopic cholecystectomy (LC) in treating the gallbladder diseases with choledocholithiasis. A retrospective study was adopted to analyze comparatively the clinical data of 152 patients with gallbladder diseases and choledocholithiasis concerning common bile duct (CBD) diameter, stone size, operation time and cost, complication rate, and the postoperative hospitalization. In the same period, 68 cases were treated by LC LCBDE, and 84 cases by EST combined with LC. There was no statistical difference in the postoperative hospitalization between two groups. But there were significant differences in CBD diameter,stone size, operation time,cost, and incidence of the complications. Conclusion]EST in combination with LC is suitable for the patients with the diameter of CBD<1.0 cm and stones impacted in the distal CBD. Whereas, LC LCBDE is the procedure of choice for the patients with CBD diameter>1.0 cm and with multiple CBD calculi, especially in merging with secondary intrahepatic bile duct calculi.