联合腹腔镜、内镜微创治疗胆囊结石合并胆总管结石

Minimal invasive treatment of cholecystolithiasis complicated with choledocholith by laparoscopic cholecystectomy combined with endoscopic intervention

目的探讨联合应用腹腔镜、内镜微创治疗胆囊结石合并胆总管结石的方法.方法 230例胆囊结石合并胆总管结石患者,106例行经内窥镜Oddi 括约肌切开取石+腹腔镜胆囊切除术(EST+LC),124例行开腹胆囊切除+胆总管切开取石T管引流术,比较两组患者术后镇痛药使用、切口感染、胃肠道功能恢复情况、住院时间、并发症等.结果两组患者结石取净率均为100%,均未出现严重并发症.开腹手术组:术后切口感染率10.5%,平均住院(15.3±1.7)d ;EST+LC组:未出现切口感染,术后发生胆漏1例,保守治疗痊愈,平均住院(8.1±1.2)d.随访1个月～8年,开腹手术组2例复发胆总管结石.两组患者术后恢复情况比较差异有统计学意义(P<0.05).结论与传统开腹手术相比,EST+LC具有创伤小、恢复快、住院时间短等优点,安全有效,可根据条件选择作为胆囊结石合并胆总管结石患者的微创治疗方法之一.

Objective To investigate the minimal invasive treatment of cholecystolithiasis complicated with choledocbolith by laparoscopic cholecystectomy （LC） combined with endoscopic treatment （EST）. Methods Of 230 patients suffering from cholecystolithiasis combined with choledocholith, 106 underwent Oddis sphincter incision by endoscope combined with LC （EST ＋ LC） and 124 received routine cholecystectomy and common duct incision with T - tube drainage. Postoperative usage of analgesic, wound infection, recovery of gastrointestinal tract, hospital stay and other complications were compared between the two groups. Results Stone clearance rates were 100 % in both groups without any severe complications. Wound infection rate was 10.5 % and average hospital stay 15.3 ± 1.7 days in routine operation group, while no wound infection occurred and hospital stay 8.1 ± 1.2 days in EST ＋ LC group. One case was complicated with bile leakage postoperation that was cured by conservative therapy in EST＋ LC group. After 1 month to 8 year follow - up, 2 patients suffered from recurrence of choledocholith. There was significant difference in recovery of gastrointestinal tract between the two groups （ P 〈 0.05 ）. Conclusion Laparoscopic cholecystectomy combined with endoscopic intervention, which has the advantages of minimal invasion, quick recovery and short hospital stay with safe and effective outcomes, may become one of the best therapeutic choices of cholecystolithiasis complicated with choledocholith.