胆总管结石内镜和手术治疗效果的对照分析

Effect of endoscopic treatment for common bile duct stone comparing to surgery

目的对照分析内镜和手术治疗胆总管结石的效果。方法胆总管结石471例,其中内镜治疗365例,常规外科手术106例。采用EST、Pre-cut、EST后ENBD等方法,比较内镜治疗和常规手术治疗的效果,以及在适应症、并发症发生率和医疗费用等方面的不同。结果365例胆总管结石内镜取石成功359例,成功率98.36%。EST后总的早期并发症为10.86%(39/359),原因主要为胆管炎,占61.54%(24/39),而EST后行ENBD者早期并发症仅为2.96%(8/270),EST无后期并发症。内镜取石平均住院时间仅为3d。开腹手术创伤大,可产生胆管狭窄、胆管炎、肝功损害等并发症,住院时间7～18d,平均12d,EST的医疗费用显著低于开腹手术。结论EST对胆总管结石在住院时间、费用和并发症发生率方面都明显优于常规手术。

Objective To evaluate the value of EST and surgery in the treatment of common bile duct stone. Method Four-hundred and seventy-one patients with common bile duct stone were studied, among which 365 cases were treated by endoscopy and 106 cases were treated by routine surgery. The outcome of operation, the skill of EST, the application of Pre-cut, and the need of ENBD after EST were evaluated. Result Three-hundred and fifty-nine patients with common bile duct stone were successfully treated by the stone extraction with endoscopy, with success rate being 98.36%. The total early complication rate after EST was 10.86% （39/359） which was mainly cholangitis, accounting for 61.54% （24/39）. The early complication rate after ENBD was only 2.96% （8/270）. There was no late complication after EST. The average hospitalization time of patients in EST group was 3 days. In surgery group there were more organ injuries, including biliary tract stricture, cholangitis, and liver function damage. The average hospitalization time in operation group was 12 days. The medical expenditure in EST group was significantly cheaper than routine operation group. Conclusion EST for common bile duct stone patients is of more benefits than routine surgery in hospitalization time, medical expenditure and complications.