肝外胆管结石的微创治疗

Minimally invasive procedure in treating gallbladder calculi with choledocholithiasis

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+胆总管探查术(common bile ductexploration,CBDE)与内镜下Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊疾病合并胆总管结石的临床效果及术式选择。方法:2001年4月～2007年12月我院采用微创外科技术治疗胆囊结石合并胆总管结石患者66例,其中LC+CBDE组48例,EST组18例,比较两组患者的手术时间、术中出血量、术后肠功能恢复时间、术后住院天数、住院总费用、并发症发生率、结石消除率等指标。结果:LC+CBDE组与EST组手术时间、术中出血量、术后肠功能恢复时间、结石消除率等指标差异无显著性(P>0.05),LC+CBDE组住院总天数、住院总费用、并发症发生率明显少于EST组(P<0.01)。结论:两种术式各有其适应证和优缺点,胆总管直径<1.0cm时以行EST取石术为宜,2～5d后再行LC。既往有胆道手术史者亦EST取石为宜。胆总管直径>1.0cm,尤其是并存二级胆管结石者(无胆管狭窄)则宜行LC+CBDE。

Objective ： To investigate the clinical effect of laparoscopic cholecystectomy （ LC ） ＋ common bile duct exploration （CBDE） and endoscopic sphincterotomy（EST） combined with LC on treating the gallbladder disease with choledocholithiasis. Methods：The two minimally invasive procedures were carried out, which had sixty-six cases of cholecystolithiasis and common duct stones from Apr. 2001 to Dec. 2007. The patients were divided into two groups,with LC ＋ CBDE group 48 cases and EST group 18 cases respectively. The clinical data were compared, such as operative time, blood loss, gastrointestinal function recovery time, postoperative hospitalization, cost, incidence of complication and clearance rate of stone. Results：There was no significant difference between the two groups about operative time,blood loss,gastrointestinal function recovery time and clearance rate of stone. （P 〉0.05 ）. But there were significant differences in the postoperative hospitalization, cost, incidence of complication （P 〈 0.01 ）. Conclusions：There are respective indication, advantage and disadvantage between the two groups. If the common bile duct is less than 1.0cm in diameter, EST should be perfomed at first,followed with LC 2-5 days later. Otherwise, the better way is LC ＋ CBDE, especially for secondary intrahepatic bile duct calculi（ not complicated with stricture of bile duct）.