内镜下括约肌切开与腹腔镜胆总管探查治疗胆总管结石疗效对比及适应群体

目的探讨内镜下括约肌切开与腹腔镜胆总管探查治疗胆总管结石的效果,分析其主要适用群体。方法收集2008年6月至2012年6月胆总管结石患者126例,其中74例给予腹腔镜胆总管探查治疗(A组),52例给予内镜下括约肌切开治疗(B组),比较2组患者手术成功率、残石率、术后并发症发生率、手术时间、住院时间及治疗费用等。结果 2组手术成功率差异无统计学意义(P>0.05);A组术后残石率为16.2%,B组术后胆囊病变及肝内外胆管结石残留率为40.4%,2组差异有统计学意义(P<0.05);A组术后并发症发生率(8.1%)明显低于B组(25.0%),组间差异有统计学意义(P<0.05);2组平均住院时间、治疗费用比较,差异无统计学意义(P>0.05)。结论内镜下括约肌切开与腹腔镜胆总管探查治疗胆总管结石的成功率均较高,是安全、有效的微创治疗方法;其中腹腔镜探查适用于括约肌功能完好,胆总管结石,或合并胆囊结石患者,内镜下括约肌切开适用于括约肌功能减退,单纯胆总管结石或伴炎症者。

Efficacy comparion of endoscopic sphincterotomy and laparoscopic bile duct exploration in treatment of choledocholithiasis and its adaptation crowd

Objective To investigate the efficacy of endoscopic sphincterotomy(EST) and laparoscopic bile duct exploration(LCBDE) in the treatment of choledocholithiasis and analyze its main adaptation crowd.Methods A total of 126 cases of patients with choledocholithiasis admitted to our hospital from June 2008 to June 2012 were selected,of which 74 patients were given LCBDE treatment(group A) and 52 were given EST treatment(group B).Surgical success rate,residual rate,incidence of postoperative complications,operative time,length of stay,treatment cost and other indicators in two groups were compared.Results The surgical success rate of two groups was not significantly different(P>0.05);postoperative residual stone rate of group A was 16.2 %,that of group B was 40.4%,and the difference was significant(P<0.05);postoperative complication rate(8.1%) of group A was significantly lower than that of group B(25.0%),and the difference was statistically significant(P<0.05);when mean hospital stay and treatment cost of two groups were compared,the difference was not statistically significant(P>0.05).Conclusion The success rate of EST and LCBDE for choledocholithiasis is high;it is a safe,effective and minimally invasive treatment method;LCBDE is suitable for patients with intact sphincter function,common bile duct stones,or gallbladder stones;EST is suitable for patients with sphincter dysfunction,common bile duct stones alone or accompanied by inflammation.