内镜腹腔镜联合与腹腔镜下治疗胆囊并胆总管结石临床分析评价

The clinical analysis and evaluation of EST combined with LC and LCHTD for the treatment of cholecystolithiasis and choledocholithiasis

目的探讨内镜下乳头括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)和腹腔镜胆囊切除胆总管探查取石术(LCHTD)治疗胆囊并胆总管结石的效果。方法回顾性分析胆囊并胆总管结石分别采用EST联合LC(468例)和LCHTD(268例)治疗患者的临床资料,对结石清除率、并发症发生率、中转开腹率和住院天数等指标进行比较。结果EST+LC组和LCHTD组在结石清除率(97.2%vs.97.4%)差异上无统计学意义(P>0.05),但LCHTD组比EST+LC组并发症发生率低(1.5%vs.6.4%)(P<0.01),住院时间短(10dvs.15d)(P<0.01),中转开腹率高(6.7%vs.5.2%)(P<0.05)。LCHTD组的远期疗效(96.6%)明显优于EST+LC组(90.6%)(P<0.01)。结论EST联合LC操作技术要求低,LCHTD操作难度大;LCHTD远期疗效优于EST联合LC。应根据具体情况采取个体化的治疗方法。

Objective To compare the effect of combined endoscopic sphincterotomy （ EST ） and laparoseopic cholecystectomy （LC） with combined laparoscopic choledocholithotomy-T-tube drainage （LCHTD） and LC for the treatment of eholecystolithiasis and choledochothiasis. Methods We retrospectively analyed the clinical data of patients with cholecystolithiasis and choledocholithiasis treated by EST combined with LC （468 cases ） , and by LCHTD combined with LC （268 cases ）. The stone-clearance rates, complication rate, conversion rate of open operation and hospital length of stay in the two groups were compared. Results The stone-clearance rate was 97. 2% （455/468） in the EST ＋ LC group compared with 97. 4% （261/268） in the LCHTD ＋ LC group, and difference was no statistical （ P 〉 0.05 ）. But the complication rate was 6.4% in the EST ＋ LC group compared with 1. 5% in the LCHTD ＋ LC group, and difference was obvious （P〈0.01）. Hospital length of stay was a median of 15 days in the EST ＋ LC group,and 10 days in the LCHTD ＋ LC group. The long-term effect of LCHTD ＋ LC group （ 96.6% ） was better than that of EST ＋ LC group （ 90.6 % ） （ P 〈 0.01 ）. Conclusions EST combined with LC is technically easier, however LCHTD is much harder to handle, but the effect of LCHTD combined with LC is superior to that of EST with LC. For patients with eholecystolithiasis and choledoehliothiasis, the treatment method of choice must be individualized.