胆总管结石内镜治疗术式的选择

The selection of endoscopic method for treatment of common bile duct stones

目的探讨内镜时代治疗胆总管结石治疗的恰当术式。方法回顾性分析2004年1月—2008年7月采用ERCP,LC+ERCP及腹腔镜胆总管探查术(LECBD)等诊断、治疗可疑胆总管结石309例患者的临床资料。结果有216例行ERCP诊治,其中胆总管结石97例,占44.9%,因可疑胆总管结石行ERCP诊治的患者数逐年减少。93例行LECBD,其中71例成功,22例中转开腹。71例成功者中,经胆总管直接切开途径60例,经胆囊管途径11例,采用一次性胆总管缝合6例,行LECBD治疗的患者数逐年增多。ERCP+LC与LECBD相比两者在手术成功率、出血量、残石率方面差异无统计学意义(均P>0.05);LECDB组的手术时间、手术并发症及住院时间均低于LC+ERCP组(均P<0.05)。结论LECBD治疗胆总管结石优于LC+ERCP。但在内镜技术高度发展的时代,选择个体化治疗方案是胆总管结石治疗的最佳术式。

Objective To explore the appropriate operative methods for the treatment of CBD （common bile duct ） stone in endoscopic era. Methods We retrospectively analyzed the diagnosed and treated data of 309 patients with suspected CBD stones with ERCP, LC ＋ ERCP and LECBD （ laparoscopic exploration of the common bile duct） from January 2004 to July 2008 in our hospital. Results A total of 216 patients received ERCP, among them 97 （44.9%） cases had CBD stone, and there was the trend that the number of patients who received ERCP reduced yearly. Among the 93 patients who received LECBD, 71 cases were successful and 22 cases were converted to open operation. Of the 71 cases, transcystic duct CBD exploration was done in 11 cases, direct CBD exploration in 60 cases, and 6 cases had primary closure of CBD. The number of cases that received LECBD grew steadily with time. There was no difference in successful operative rate, intraoperative bleeding and residual calculi rate between ERCP ＋ LC and LECBD group. The operative time, postoperative complications and length of hospital stay in LECBD. group were significantly lower than those in LC ＋ ERCP group. Conclusions LECBD is better than LC ＋ ERCP in the treatment of CBD stones, but in the endoscopic era, the selection of an individualized treatment approach is the best operative method for the management of CBD stone.