腹腔镜下胆道探查与内镜Oddi括约肌切开取石的研究

The evaluation of laparoscopic common bile duct exploration and laparoscopic cholecystectomy with endoscopic sphincterotomy on patients with common bile duct stones

目的:探讨腹腔镜胆道探查取石,T管引流术和腹腔镜胆囊切除一期联合内镜Oddi括约肌切开取石治疗胆总管结石合并胆囊结石的临床应用价值。方法:统计分析研究组(77例腹腔镜胆道探查取石即LCH- TD及43例腹腔镜胆囊切除一期联合内镜Oddi括约肌切开取石即LC- EST)与对照组(60例常规开腹胆总管探查即OCHTD)胆总管结石合并胆囊结石患者的临床资料。结果:研究组胆总管结石合并胆囊结石120例中111例行微创手术取得成功,占92. 5%,与对照开腹探查组相比,术后恢复较好,住院时间短,取得了较满意的效果(P<0 .05);研究组中运用LCH -TD的患者较LC EST的患者手术操作时间、术后腹痛、恶心及住院天数差异有显著性(P<0. 05)。两者在胆总管内径及结石大小方面差异亦有显著性(P<0. 05)。结论:LCH -TD与LC -EST两种术式微创,安全且临床疗效可靠,能代替大部分开腹胆总管探查术;腹腔镜胆总管探查取石法总体上优于腹腔镜胆囊切除一期联合内镜Oddi括约肌切开取石法。胆总管直径>1 0cm者行LCH- TD是一种安全可行的方法。若胆总管内径<1cm,且胆总管结石<1 0cm,建议行LC- EST。

Objective:To evaluate the clinical values of laparoscopic choledocholithotomy Ttube drainage (LCHTD) and laparoscopic cholecystectomy with endoscopic sphincterotomy (LCEST) on patients with common bile duct stones.Methods:A total of 180 cases were studied,of which,77 cases received LCHTD,43 cases received LCEST and 60 cases received open choledocholithotomy Ttube drainage (OCHTD),respectively.Results:The microinvasive operation, LCHTD or LCEST,were performed successfully on 92 5%(111/120) of the patients,and they were superior to traditional OCHTD significantly. There were meaningful differences between LCHTD and LCEST on operating time,postoperative complications,and hospitalization time.However,the indications for LCHTD and LCEST were different, for instance,on diameters of common bile duct and sizes of stones.Conclusions:Both LCHTD and LCEST are safe,microinvasive and suitable for patients with common bile duct stones.Moreover, LCHTD is better than LCEST in terms of clinical therapeutic values. Prospecting from our research LCHTD and LCEST can replace most traditional OCHTD in the future.