三种不同方式治疗胆囊结石合并胆总管结石疗效分析

Comparison of three different modalities for cholecystolithiasis combined effect of choledocholithiasis

目的探讨3种不同的外科治疗手段对胆囊结石合并胆总管结石的疗效异同，为临床治疗提供依据。方法2003年10月至2007年10月本院普外科住院治疗的胆囊结石合并胆总管结石患者192例，随机分为3组，63例行腹腔镜胆囊切除、胆总管探查、T管引流术（A组），66例行腹腔镜胆囊切除联合内镜乳头括约肌切开取石术（B组），63例行例开腹胆囊切除、胆总管切开取石、T管引流术（c组），比较3组患者的手术及术后情况。结果3组中A组手术时间、住院时间及术后用药时间均少于其他2组（P〈0．05）；C组并发症的发生程度较重；3组患者术中出血量及并发症的发生率比较差异无统计学意义（P〉0．05）。结论腹腔镜胆囊切除、胆总管探查、T管引流术是治疗胆囊结石并胆总管结石的较好术式，能缩短住院时间和术后用药时间，降低患者的费用，值得推广。

Objective To evaluate the therapeutic effect of 3 different treatments for cholecystolithiasis combined effect of choledocholithiasis. Methods From October 2003 to October 2007,192 cases were randomized into three groups,63 cases were received T-tube drainage（ group A）after laparoscopic cholecystectomy and choledochotomy,66 cases were received endoscopic sphincterotomy and laparoscopic cholecystectomy（ group B） and 63 cases were received open cholecystectomy and open choledocholithotimy T-tube drainage（ group C）. Resuits Compared with other groups,the average operating time,the average hospital stay and treatment time in group A was shorter（P 〈0. 05）. There were no significant difference in blood loss and complication morbidity during operation among the 3 groups. Conclusion T-tube drainage after laparoscopic cholecystectomy and choledochotomy is a safe and feasible technique with affirmative curative effect and mild invasion. This operation preserve the function of Oddi,and shortened the hospital stay,tratment time and it relieved the cost of patients.