腹腔镜胆囊切除胆道探查取石术与内镜下Oddi括约肌切开取石联合腹腔镜胆囊切除术的疗效比较

Laparoscopic cholecystectomy plus exploration of the common bile duct in comparison with laparoscopic cholecystectomy and endoscopic sphincterotomy for secondary choledocholithiasis

目的比较腹腔镜胆囊切除（1aparoscopic cholecystectomy，LC）胆道探查取石（laparoscopic common bile duct exploration，LCBDE）与内镜下Oddi括约肌切开（endoscopic sphincterotomy，EST）取石联合LC两种方法治疗继发性胆总管结石的疗效。方法回顾性分析2008年1月至2009年12月我院收治的采用LC＋LCBDE或EST＋LC治疗的继发性胆总管结石患者的临床资料，对比两种方法的手术成功率、手术时间、术后并发症、残石率、住院时间、住院费用等。统计学处理，计数资料用X2检验，计量资料采用独立样本￡检验。结果共收治继发性胆总管结石患者163例，有87例行LC＋LCBDE，76例行EST＋LC。二者相比，LC＋LCBDE手术时间较EST＋LC平均缩短30min、住院时间缩短3d、术后并发症少、费用低，二者手术成功率、残石率无显著差异。结论治疗继发性胆总管结石，LC＋LCBDE安全、有效，并发症少，在病情允许情况下，可作为首选方法。

Objective To compare the effects between laparoscopic cholecystectomy （LC） ＋ laparoscopic common bile duct exploration （ LCBDE ） and endoscopic sphincterotomy （EST） ＋ laparoscopic cholecystectomy（ LC ） for secondary choledoeholithiasis. Methods The clinical data of patients with secondary choledocholithiasis receiving LC ＋ LCBDE or EST ＋ LC from January 2008 to December 2009 were retrospectively compared. Parameters included operation time, postoperative complication, length of stay, cost of hospitalization. All patients received follow up of 1 year. Enumeration data was analyzed by chi- square test and measurement data was analyzed by t test. Results In this study 87 patients received LC ＋ LCBDE ,76 patients received EST ＋ LC. Patients in LC ＋ LCBDE group had shorter hospital stay, less hospital charges and less complications. There was not difference in the procedure success rate and stone remanent rate between the two groups. Conclusions LC ＋ LCBDE could be used as the first choice for patients with gallstones and secondary choledocholithiasis.