EST联合LC治疗胆囊结石合并胆总管结石的临床研究

目的探讨十二指肠镜乳头括约肌切开术（endoscopic sphinc terotomy,EST）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗胆囊合并胆总管结石的临床疗效。方法回顾性分析85例胆囊结石合并胆总管结石患者的治疗方法和结果。其中30例行EST＋LC,55例行开腹胆囊切除、胆总管切开取石、T管引流术（OC＋OCHTD）。结果 EST＋LC组、OC＋OCHTD组患者的治疗成功率、并发症发生率无显著性差异（P〉0.05）,但EST＋LC组术后并发症严重程度较轻。EST＋LC组的胃肠功能恢复时间、住院时间较OC＋OCHTD组明显缩短（P〈0.05）。术后53例患者获得随访,随访时间3～37个月（平均18.5个月）,均无胆管结石复发或胆管炎发生。结论应用EST＋LC联合治疗胆囊结石合并胆总管结石的临床疗效满意,具有创伤小,术后恢复快,住院时间短的优点。

Study on Endoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy for the Treatment of Gallstones Complicated with Common Bile Duct Stones

Objective To evaluate the curative effect of endoscopic sphincterotomy（EST） combined with laparoscopic cholecystectomy（LC） in the treatment of gallstones complicated with common bile duct stones.Methods A retrospective study was adopted to analyze comparatively the clinical date of 85 patients of gallstones complicated with common bile duct stones treated with different ways.30 patients were treated by EST＋LC,and 55 patients were treated by OC＋OCHTD.The clinical date of two groups was contrasted and underwent statistical analyze.Results There were no statistical difference in the success rate and post operative complication rate between two groups,but the post operative complication of the EST＋LC group is less serious than that of the OC＋OCHTD group.There were statistical difference in the recovery time of gastroenteric function and the hospital stay.53 patients received regular follow up for 3～37 months（average 18.5 months）,none of whom was found common bile duct recurrence and cholangitis.Conclusions EST combined with LC can give good therapeutic results for treating gallstones complicated with common bile duct stones and it has advantages of less trauma,few complications and quick recovery.