内镜与开腹手术在治疗胆总管结石中的对比研究

Contrast study on choledochalithiasis therapy using endoscopic versus open surgical procedure

目的研究内镜与开腹手术在治疗胆总管结石病人中各自的优缺点。方法对内镜治疗和同期开腹手术治疗的各30例胆总管结石病人资料进行回顾性研究,比较两组手术前后的相关指标。结果开腹手术组术后1 d血清转氨酶、外周血白细胞总数明显高于内镜组(P<0.01)。内镜组手术前后体温无明显变化,开腹手术组体温则明显升高,剖腹手术组术后3 d内平均体温明显高于内镜治疗组。内镜组术后抗菌药物使用时间、恢复饮食时间和平均住院时间较开腹组显著缩短。结论内镜治疗胆总管结石与开腹手术相比具有恢复快、痛苦小、并发症少的优点,但其一次结石取净率较开腹手术低,需要改进器械,提高技术来完善。内镜治疗胆总管结石具有良好的应用前景。

Objective: To evaluate the advantage and shortcoming of choledocalithiasis therapy using endoscopic versus open surgical procedure. Methods: The data of 60 patients with choledocalithiasis underwent endoscopic or laparotomized therapy (30 cases each group) were retrospectively analyzed. The related indexes were compared between two groups preoperatively and postoperatively. Results: On the 1st day after operation, the serum transaminase value and white blood cell counts of laparotomy group were significantly higher than those of endoscopy group (P <0.01). The mean temperature of endoscopy group had no markedly change between preoperative and postoperative test, but in laparotomy group that increased postoperatively. The mean temperature of laparotomy group was notably higher than that of endoscopy group in the 3 days after operation. The mean period of antibiotic application, diet recovery, and hospitalization of endoscopy group was significantly shorter than laparotomy group. Conclusion: The endoscopic therapy of choledocalithiasis has benefits of quicker restored time, lighter pain, and less complications compared with laparotomized treatment. But endoscopic approach has lower complete calculous extractive rate in the first time, and needs to improve instruments and technique. Endoscopic therapy has good potentiality for the choledocalithiasis.