两种微创方案治疗胆囊结石并胆总管结石的疗效对比(1)
摘要：目的 比较腹腔镜胆囊切除术(LC)+胆道镜胆总管探查取石术(LCBDE)与LC+内镜下十二指肠乳头括约肌切开取石术(EST)治疗胆囊结石并胆总管结石的临床疗效。方法 收集我院2013年1月～2017年12月收治的胆囊结石合并胆总管结石患者104例作为研究对象，按照手术方法分为LC+LCBDE组和LC+EST组，各52例。比较两组患者手术时间、术中出血量、住院时间、并发症发生率以及Oddis括约肌损伤发生率。结果 LC+LCBDE组患者的手术时间(131.52±25.71)min、住院时间(8.13±2.35)d、并发症发生率(15.38%)、Oddis括约肌损伤发生率(3.85%)均低于LC+EST组的(167.12±35.24)min、(10.37±3.25)d、48.07%、25.00%，差异均有统计学意义(P<0.05);两组术中出血量比较，差异无统计学意义(P>0.05)。结论 LC+LCBDE和LC+EST均是治疗胆囊结石并胆总管结石的有效微创手段，LC+LCBDE方案具有手术时间短、住院时间短、并发症发生率低的优点，同时能保护Oddis括约肌的正常功能，具有一定的优越性。
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关键词：胆总管结石;腹腔镜;胆道镜取石术;乳头括约肌切开取石术
中图分类号：R657.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.038
文章编号：1006-1959(2019)07-0126-03
Abstract：Objective To compare the clinical outcomes of laparoscopic cholecystectomy (LC) + choledochoscopy with common bile duct exploration (LCBDE) and LC + endoscopic duodenal papillary sphincter incision (EST) for the treatment of gallbladder stones and common bile duct stones. Efficacy.Methods A total of 104 patients with gallstones complicated with common bile duct stones admitted to our hospital from January 2013 to December 2017 were enrolled. The patients were divided into LC+LCBDE group and LC+EST group， 52 cases each. The operation time， intraoperative blood loss， hospitalization time， complication rate and incidence of Oddis sphincter injury were compared between the two groups.Results The operation time (131.52±25.71) min， hospitalization time (8.13±2.35) d， complication rate (15.38%) and Oddis sphincter injury rate (3.85%) were lower in the LC+LCBDE group than in the LC+EST group(167.12±35.24) min， (10.37±3.25)d， 48.07%， 25.00%， the difference was statistically significant (P<0.05). There was no significant difference in the amount of intraoperative blood loss between the two groups (P>0.05).Conclusion LC+LCBDE and LC+EST are effective minimally invasive methods for the treatment of gallstones and common bile duct stones. LC+LCBDE has the advantages of short operation time， short hospital stay and low complication rate， and can protect Oddis sphincter. Normal function has certain advantages.
, 百拇医药
Key words：Common bile duct stones;Laparoscopy;Choledochoscopy stone removal;Papillary sphincter incision
胆囊结石(cholecystolithiasis)是一种常见疾病，发病率10%～15%，隨着生活水平的提高，饮食习惯的改变，中国胆囊结石合并胆总管结石发生率也在不断增加[1]。国内文献报道胆囊结石合并胆总管结石的发病率为10%～15%[2]。胆囊结石合并胆总管结石具有病程短、症状明显、容易引起胆源性胰腺炎等特点。对该病手术治疗的特殊性在于其治疗策略要同时包括胆总管结石和胆囊结石两个方面[3]，以往以传统开腹手术(胆囊切除+胆道切开探查+T管引流术)为主，近年来随着微创外科的发展，对新的治疗策略的探索一直是该领域的热点[4]。治疗胆囊结石合并胆总管结石常用的微创方案有腹腔镜胆囊切除术(LC)+胆总管探查术中胆道镜取石术(LCBDE)、LC+内镜下十二指肠乳头括约肌切开取石术(EST)[4]，目前对于选择哪种手术方式更能让患者获益仍然存在争议。为此，本研究探讨LC+LCBDE与LC+EST治疗胆囊结石并胆总管结石的临床疗效，旨在为临床治疗方案的选择提供参考。, 百拇医药(王玉虎 韩双喜 高娜)
, http://www.100md.com
关键词：胆总管结石;腹腔镜;胆道镜取石术;乳头括约肌切开取石术
中图分类号：R657.4 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.038
文章编号：1006-1959(2019)07-0126-03
Abstract：Objective To compare the clinical outcomes of laparoscopic cholecystectomy (LC) + choledochoscopy with common bile duct exploration (LCBDE) and LC + endoscopic duodenal papillary sphincter incision (EST) for the treatment of gallbladder stones and common bile duct stones. Efficacy.Methods A total of 104 patients with gallstones complicated with common bile duct stones admitted to our hospital from January 2013 to December 2017 were enrolled. The patients were divided into LC+LCBDE group and LC+EST group， 52 cases each. The operation time， intraoperative blood loss， hospitalization time， complication rate and incidence of Oddis sphincter injury were compared between the two groups.Results The operation time (131.52±25.71) min， hospitalization time (8.13±2.35) d， complication rate (15.38%) and Oddis sphincter injury rate (3.85%) were lower in the LC+LCBDE group than in the LC+EST group(167.12±35.24) min， (10.37±3.25)d， 48.07%， 25.00%， the difference was statistically significant (P<0.05). There was no significant difference in the amount of intraoperative blood loss between the two groups (P>0.05).Conclusion LC+LCBDE and LC+EST are effective minimally invasive methods for the treatment of gallstones and common bile duct stones. LC+LCBDE has the advantages of short operation time， short hospital stay and low complication rate， and can protect Oddis sphincter. Normal function has certain advantages.
, 百拇医药
Key words：Common bile duct stones;Laparoscopy;Choledochoscopy stone removal;Papillary sphincter incision
胆囊结石(cholecystolithiasis)是一种常见疾病，发病率10%～15%，隨着生活水平的提高，饮食习惯的改变，中国胆囊结石合并胆总管结石发生率也在不断增加[1]。国内文献报道胆囊结石合并胆总管结石的发病率为10%～15%[2]。胆囊结石合并胆总管结石具有病程短、症状明显、容易引起胆源性胰腺炎等特点。对该病手术治疗的特殊性在于其治疗策略要同时包括胆总管结石和胆囊结石两个方面[3]，以往以传统开腹手术(胆囊切除+胆道切开探查+T管引流术)为主，近年来随着微创外科的发展，对新的治疗策略的探索一直是该领域的热点[4]。治疗胆囊结石合并胆总管结石常用的微创方案有腹腔镜胆囊切除术(LC)+胆总管探查术中胆道镜取石术(LCBDE)、LC+内镜下十二指肠乳头括约肌切开取石术(EST)[4]，目前对于选择哪种手术方式更能让患者获益仍然存在争议。为此，本研究探讨LC+LCBDE与LC+EST治疗胆囊结石并胆总管结石的临床疗效，旨在为临床治疗方案的选择提供参考。, 百拇医药(王玉虎 韩双喜 高娜)