腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石比较

Treatment of common bile duct stone with laparoscopic common bile duct exploration and laparoscopic cholecystectomy with endscopic sphincterotomy

目的评价腹腔镜胆总管探查术（LCBDE）和内镜下十二指肠乳头括约肌切开术（EST）及其联合腹腔镜胆囊切除术（LC）的临床疗效。方法回顾分析2005年9月至2009年1月本院普外科83例胆总管结石合并胆囊疾病患者的临床资料，其中行LCBDE术48例、EST—LC术35例。结果两种术式手术成功率、手术时间、结石大小、术后并发症发生率、残余结石、结石复发比较差异无统计学意义（P〉0．05），结石数量、术后疼痛、住院费用、术后住院时间比较差异有统计学意义（P〈0．05）。结论LCBDE和EST—LC两种微创手术成功率高、安全、并发症少、患者痛苦少、临床疗效可靠，是治疗胆总管结石合并胆囊疾病的理想手术。

Objective To evaluate the clinical outcomes of the laparoscopic common bile duct exploration（LCBDE） and laparoscopic cholecystectomy with endoscopic sphincterotomy（ EST - LC ）. Methods The clinical date of 83 cases which had choledocholithiasis combining with gall bladder diseases was analyzed from Sep 2005 to Jan 2009,including 48 cases of LCBDE and 35 cases of EST - LC. Results There was no statistical difference （ P 〉 0.05 ） in successful rate, operative time, diameter of stone, complication occurrence, residual stone, stone recurrence. But there was statistical difference （ P 〈 0.05 ） in the number of stones, occurrence of postoperative pain, cost of hospitalization, postoperative stay. Conclusion Both LCBDE and EST - LC are safe and reliable procedures. These procedures have a low rate of complications, imply a shorter postoperative stay, and offer the patients a more comfortable postoperative period. They are ideal procedures for treating choledocholithiasis with gallbladder diseases.