经十二指肠镜括约肌切开术后行腹腔镜胆囊切除时机探讨

目的探讨经十二指肠镜括约肌切开术（EST）术后腹腔镜胆囊切除术的手术时机。方法胆囊结石合并胆总管结石患者180例分为3组，均行EST联合LC，随机并按其EST术后手术时间分为3组。分别于EST术后3d（A组），7d（B组），30d（C组）行腹腔镜胆囊切除，并对其资料进行回顾性分析，术中和术后临床资料单因素方差分析。结果EST术后7d组腹腔镜胆囊切除手术时间（51．00±2．31）min明显较A组（34．70±2．24）min、C组（34．43±2．51）min延长（t=0．002，P〈0．01）；中转开腹率10．0％（6／60）较A组1．7％（1／60）、C组1．7％（1／60）明显增高（t=0．028，P〈0．05）；术中出血量（50．43±3．90）ml较A组（28．86±3．35）ml、C组（28．57±3．40）ml明显增多（t=0．003，P〈0．01），差异有统计学意义。EST术后30d组腹腔镜胆囊切除住院总费用（15250．57±1006．67）元较A组（10093．29±496．05）元、B组（10845．86±744．27）元明显增加（t=0．002，P〈0．01）。结论EST术后3d行腹腔镜胆囊切除可降低手术难度与中转开腹率，缩短手术时间，手术安全有效，优势明显。

Operation timing of cholecystectomy after endoscopic sphincterotomy

Objective To investigate the operation timing of cholecystectomy after endoscopic sphincterotomy. Methods From October 2008 to October 2012, 180 patients with cholecystolithiasis and choledocholithiasis received EST combined with LC. They were divided randomly into 3 groups according to the operation timing after EST： laparoscopic cholecystectomy 3 days （ group A）, 7 days （ group B ）, and 30 days （group C） after EST. The clinical data of the 180 patients were analyzed retrospectively by using SPSS13.0 software, including variance analysis of single factors. Results In group B, operation time of laparoscopic cholecystectomy （51.00 ± 2.31 ） min was significantly higher than （34.70 ± 2.24 ）min in group A and （34.43 ± 2.51 ） min in group C （ t = 0. 002, P 〈 0.01 ）. The intraoperative conversion rate 10.0% （6/60） ] in group B was higher than that 1.7 % （1/60） ] in group A, and that 1.7% （1/60） ] in group C （ t = 0. 028, P 〈 O. 05 ）. The amount of bleeding （50.43 ± 3.90） ml ] in group B was larger （28.86 ± 3.35） ml] than that in group A and group C （28.57 ± 3.40）ml] （t =0. 003, P 〈0.01）. The cost of hospitalization for group C was （15250. 57 ± 1006. 67 ） yuan which was more than （10093.29 ± 496.05） yuan in group A, and （10845.86 ± 744.27） yuan in group B （t =0. 002, P 〈0. 01 ）. Conclusion Laparoscopic cholecystectomy performed 3 days after EST could reduce the operation difficulty and conversion rate, and shorten the operation time. This modality is safe and effective.