双镜联合治疗胆石病的两种术式的对比研究

The comparative analysis of two kinds of ways combined two en- doscopes in treating cholelith

目的比较腹腔镜胆囊切除、胆总管探查联合胆管镜取石（A方法）与十二指肠镜联合腹腔镜胆囊切除术（B方法）治疗胆石病的效果及优缺点。方法回顾性分析42例胆总管结石合并胆囊结石采用A方法与72例采用B方法治疗的临床资料，比较两组患者的手术时间、术中出血量、术后镇痛率、中转开腹数、结石残留率、术后并发症率、住院总费用和住院总时间等指标，进行统计学对比分析。结果两种术式的结石残留率、中转开腹率、各项并发症率及住院总费用比较差异有统计学意义（P〈0．05），而其余指标比较差异无统计学意义（P〉0．05）。结论两种术式具有各自的优缺点，需根据患者术前影像学检查及具体病情等采用个体化的治疗方案。

Objective To compare the effects of laparoseopic cholecysteetomy and laparoseopic common bile duct exploration combined choledochoscopie exploration （ method A）and duodenoscopic sphineterotomy combined with laparoscopic cholecystectomy（ method B） in treating eholedocholithiasis with cholecystohthiasis. Methods A retrospective study was adopted to analyze by statistical methods comparatively the clinical data of 114 patients, concerning operation time, blood lost, odynolysis rate, conversion rate, calculi residual rate , complication rate , hospitalization time and cost, et al. 68 cases were treated by method A, and 72 cases were treated by method B. Results There were statistical differences in calculi residual rate, a conversion rate, apart complication rates and hospitalization cost between two groups, but there was no statistical difference in other index. Conclusion The two methods for choledocholithiasis and cholecystohthiasis has advantage and shortcoming respectively. The treatment for patients must be individualized by MRCP/USG, actual state of illness, and so on.