胆总管结石内镜和手术治疗效果评价

Therapeutic Effect of Endoscope and Surgery on Common Duct Stone

目的：评价EST和外科手术在胆管结石治疗中的价值。方法：胆总管结石395例,其中内镜治疗365例,常规外科手术30例。探讨EST后放置ENBD的必要性,观察内镜治疗和常规手术治疗的效果,以及在适应证、并发症发生以及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10.86%（39/359）,分析原因主要为胆管炎,占61.54%（24/39）,而EST后常规放置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3 d。开腹手术创伤大,可产生胆管狭窄、胆管炎、肝功损坏后期并发症,住院时间7～18 d,平均12 d,EST的医疗费用较开腹手术明显低。结论：EST对胆总管结石在住院时间、费用和发生并发症方面都明显优于常规手术;熟练掌握选择性胆管插管,EST后放置鼻胆引流管可有效预防胆管炎和急性胰腺炎的发生。

Objective：To evaluate the value of EST and surgery in treatment of bile duct stone. Methods：Of 395 cases of common duct stone, 365 received endoscopy and 30 received surgery. The essentiality of ENBD after EST was discussed. The therapeutic effect, indication and complications and medical expense in two groups were evaluated. Results： In 359 of 365 cases undergoing endoscopy, stones were successfully removed. The successful rate was 98.36 %. The incidence of early complications after EST was 10.86 %, the main cause was cholangitis （61.54 % ）. the incidence of early complications was 2.96 % in cases with ENBD after EST. There was no long - term complications of EST. The average length of stay was 3 days in cases undergoing EST and between 7 and 18 days in cases undergoing surgery, and surgery may induce in trauma bilt stenosis, cholangitis and lever ruction injuries. The medical expense of EST was less than that of surgery. Conclusion： EST is superior to surgery in length of stay, expense and complications. Perfect selective bilt intubation, ENBD after EST may prevent from cholangitis and acute pancreatitis.