腹腔镜胆总管探查取石与EST联合LC治疗
胆结石,,胆结石；胆总管结石；腹腔镜胆总管探查术；括约肌切开术，内窥镜；胆囊切除术，腹腔镜,1资料与方法,2结果,3讨、论,参考文献：
【摘要】目的：评价腹腔镜下胆囊切除、胆总管探查术(LCCBDE)与内镜下Oddi括约肌切开术(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及术式选择。方法：回顾总结LC胆囊疾病合并胆总管结石152例，采用LCCBDE术68例、EST联合LC术84例治疗的临床资料，对胆总管内径、结石大小、总手术时间、手术费用、并发症发生率、术后住院日等进行对比并作统计学分析。结果：两种术式的术后住院日差异无显著性(P>005)，手术总时间、手术费用、并发症发生率等比较差异有显著性(P<001)，两者的胆总管内径、结石大小亦有差别。结论：两种术式各有其适应证和优缺点。胆总管直径05～10cm，胆总管下端结石时宜用EST取石，术后2～5d再行LC；胆总管直径10cm时，尤其是并存二级支肝管结石者(无胆管狭窄)则宜行LCCBDE术。【关键词】胆结石；胆总管结石；腹腔镜胆总管探查术；括约肌切开术，内窥镜；胆囊切除术，腹腔镜
The contrasting analysis between laparoscopic common bile duct exploration and endoscopic sphincterotomy combined with laparoscopic cholecystectomy in treating gallbladder diseases with choledocholithiasis
HE Gengsheng,PENG Heping, Hu Yi ze.
The First Affiliated Hospital of Nanhua University，Hengyang 421001,China；The Second Affiliated Hospital of Guangzhou Medical College
【Abstract】Objective:To evaluate the effect of LCCBDE and EST combined with LC on treating the gallbladder diseases with choledocholithiasis.Methods:sixtyeight patients with gallbladder diseases with choledocholithiasis were treated by LCCBDE, and eightyfour cases by EST combined with LC. The clinical data of the two groups was contrasted and underment statistics in the same period.Results:There was no statistical difference in the postoperative hospitalization between two groups.But there were significant differences in the bore of common bile duct, the dimension of stone, operation time, cost, and the percentage of frequency in complication.One case failed in LCCBDE and transferred to open operation. two cases of EST combined with LC were converted to open surgery.Conclusions:There are respective indications, advantages and disadvantages in the two groups.As the bore of common bile duct inferior to 10cm,EST is performed at first, after 2 or 5 days,followed with LC. Otherwise, the better way is LCCBDE,especially merging with secondary intrahepatic bile duct calculi (not combined with stricture of bile duct). ......
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