腔镜胆总管切开取石与内镜乳头括约肌切开取石的临床比较

Comparison between laparoscopic common bile duct exploration and endoscopic sphincterotomy for common bile duct stone

目的探讨腹腔镜胆总管切开取石术(LCBDE)治疗胆总管结石的可行性。方法回顾分析238例胆总管结石患者的临床资料。行内镜乳头括约肌切开取石术(EST)125例,LCBDE113例,比较两组疗效及并发症。结果术后住院日、手术时间、手术成功率及结石残留率、术后近期并发症发生率差异均无显著性(P>0.05);远期并发症两组间差异有统计学意义(P<0.05);EST组结石复发14例(11.2%),乳头狭窄9例(7.2%),胆管炎13例(10.4%);LCBDE组结石复发4例(3.5%),胆管炎2例(1.8%),无乳头狭窄。结论LCBDE治疗胆总管结石的远期疗效优于EST,是一种合理的手术方法。

Objective To investigate the rationality and advantage of laparoscopic common bile duct exploration for common bile duct stone. Methods The clinical data of 238 cases of common bile duct stone were analysed retrospectively. Among them, 125 cases underwent endoscopic sphincterotomy （EST group ） , while 113 cases had laparoscopic common bile duct exploration （ LCBDE group ）. The therapeutic effect and complications were compared between the two groups. Results There was no significant difference in operation time, postoperative hospital stay, surgical achievement ratio, bile duct retained stones, or short-term complications between the two groups （ P 〉 0. 05 ）. Long-term complications were significantly different between the two groups （P 〈 0.05 ）, in EST group, bile duct recurrent stones were seen in 14 cases （11.20 % ） , duodenal papilla stenosis in 9 cases （7.20 % ）and cholangitis in 13 cases （10.4 % ） ; in LCBDE group, bile duct recurrent stones were seen in 4 cases （3. 53% ） , cholangitis in 2 cases （ 1.8% ） and no case of duodenal papilla stenosis. Conclusions The long-term outcome of LCBDE treatment for common bile duct stone is superior to that of EST and is a rational operative method.