胆囊结石合并胆总管结石的微创治疗

Minimally invasive treatment for gallbladder stones complicated with Cholelithiasis

目的比较胆囊结石合并胆总管结石的微创与开腹手术的治疗效果。方法将120例胆囊结石合并胆总管结石患者随机分为两步微创组与传统开腹组。两步微创组54例患者第一步在十二指肠镜下行逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)和内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)取石,第二步于2～5d后行腹腔镜胆囊切除术(1aparoscopic chole-cystectomy,LC);传统开腹组66例患者采取开腹胆道探查术(open common bile duct exploration,OCBDE)。比较两组患者的手术时间、手术出血量、住院时间,治疗费用及术后并发症的发生率。结果两步微创组在手术时间、术中出血量、住院时间均优于传统开腹组(P<0.05);两步微创组术后出现并发症4例,传统开腹组出现并发症9例,差异有统计学意义(P<0.05);两组住院费用比较,差异无统计学意义(P>0.05)。结论两步微创治疗胆囊结石合并胆总管结石有疗效好、创伤小、住院时间短等优点,有取代传统剖腹手术的趋势。

Objective To evaluate the clinical value of two-step minimally invasive treatment and traditional exploratory choledochotomy and T- tube drainage for cholecystolithiasis with choledocholithiasis. Methods One hundred and twenty patients with cholecystolithiasis complicated choledocholithiasis were enrolled in this study. Fifty four patients were treated with endoscopic retrograde with cholangiopancreatography（ERCP）,endoscopic sphincterotomy （EST）, and then laparoscopic cholecystectomy（LC） after 2 ～ 5 days （ two-step minimally invasive treatment group）, while 66 patients were treated with open cholecystectomy and choledochotomy with T-tube drainage （conventional open surgery group）. Operation time, blood loss, stone size, complication rate, hospital stay and cost were observed and analyzed. Results Compared with conventional open surgery group, operation time, blood loss and hospital stay in two-step minimally invasive treatment group were significantly decreased（P 0.05）; 4 patients in minimally invasive treatment group had complications, while 9 patients had complications in conventional open surgery group, the difference was significant（P 0.05）. However, there was no statistical difference in medical cost（P 0.05）. Conclusion Two-step minimally invasive treatment is effective and feasible in the treatment of cholelithiasis with choledocholithiasis, with shorter operation time, shortet hospital stay, and less complications.