胆囊结石并胆总管结石三种手术治疗的对比研究

Comparing three types of operation for treating cholecystolithiasis with choledocholithiasis

目的评价腹腔镜胆囊切除术、胆总管探查取石术（Lc＋LCBDE）与内镜下Oddi括约肌切开联用腹腔镜胆囊切除术（EST＋Lc）、剖腹胆囊切除术、胆总管探查引流术（OC＋ECBD）3种治疗胆囊结石合并胆总管结石的临床效果。方法胆囊结石合并胆总管结石289例分别采用OC＋ECBD（O组）、LC＋LCBDE（L组）和EST＋LC（E组）治疗，其中O组132例、L组36例、E组121例，比较3组的手术总时间、术中出血量、胃肠功能恢复时间、并发症发生率、住院天数等。结果3种术式的结石残留率、胆漏发生率比较，差异无统计学意义（P〉0．05）；O组手术总时间、术中出血量、胃肠功能恢复时间、住院时间均明显长于L、E组（P〈0．01）。结论3种术式各有其适应证和优缺点。胆囊结石合并胆总管结石、单纯胆总管结石，无明显胆管感染或急性胰腺炎者适合选择LC＋LCBDE。

Objective To evaluate the different effections among laparoscopic cholecystectomy （LC） combined with bile duct exploration （LCBDE）and stone removal, LC with endoscopic sphincterotomy （ EST）, and open-cholecystectomy （ OC ） with exploration of common bile duct （ ECBD ） for treating cholecys- tolithiasis with choledocholithiasis. Methods Among 289 cases of cholecystolithiasis and choledocholithlasis, 132 patients were treated by OC with ECBD, 36 cases by LC with LCBDE, 121 cases by EST combined with LC. The stone residual rate and leakage of bile rate, operation time, the loss of blood in operation, recovery time of gastrointestinal function, length of hospital stay of the three groups were compared. Results There was no statistical difference in the stone residual rate and leakage of bile rate among the three groups, but OC with ECBD group had significantly longer operation time, more loss of blood in operation, later re- covery time of gastrointestinal function and longer hospital stay than the other groups. Conclusions There are respective indications, advantages and disadvantages in the three groups. We found that the operation of LC with LCBDE is the better choice for the patients of cholecystolithiasis with choledocholithiasis, single choledocholithiasis ; However, the patients with obviously infection of biliary tract or acute pancreatitis is not suitable for this method.