腹腔镜胆总管探查术治疗胆总管结石合并胆囊结石

Laparoscopic cholecystectomy and laparoscopic common bile duct exploration in treatment of cholecystolithiasis and choledocholithiasis

目的探讨腹腔镜胆总管探查术（LCBDE）治疗胆总管结石合并胆囊结石的临床疗效和价值。方法2006年7月至2010年6月期间对127例胆总管结石合并胆囊结石患者进行微创治疗。其中78例采用LCBDE＋腹腔镜胆囊切除术（LC）治疗，49例采用内镜十二指肠括约肌切开术（EST）＋LC治疗。比较二组的手术治疗成功率、术后并发症发生率、残余结石率、胃肠功能恢复时间、住院时间和费用等指标．并随访二组远期并发症发生率。结果LCBDE＋LC组：手术成功率94．87％，术后并发症发生率5．41％。EST＋LC组：手术成功率95．92％，术后并发症发生率12．77％。两组手术成功率差异无统计学意义（P〉0．05），术后并发症发生率差异有统计学意义（P〈0．05）。手术时间、住院费用的比较差异有统计学意义（P〈0．05）。出院后随访1～5年，平均（3．2±0．8）年，LCBDE＋LC组结石复发率、胆管积气发生率、反流性胆管炎发生率显著低于EST＋LC组（P〈0．05）。结论LCBDE＋LC是治疗胆囊结石合并胆总管结石的安全、有效、可行的微创术式，对于适宜的患者行胆总管一期缝合更能体现微创的优势。

Objective To study the use of laparoscopic cholecystectomy （LC） and laparoscopic common bile duct exploration （LCBDE） in patients with cholecystocholedocholithiasis. Methods From July 2006 to June 2010, 127 patients with cholecystocholedocholithiasis were treated either by LC＋LCBDE （n= 78） or LC4-endoscopic sphincterotomy （EST, n=49）. The treatment success rate, complications, retained bile duct stones rate, recovery of gastrointestinal function and hospital-stay were retrospectively analyzed. Results The LCBDE＋LC group： The operative success rate was 94.87%. The incidence of postoperative complications was 5.41%. The EST＋LC group： Complete removal of bile duct stones was achieved in 46 of 48 patients （95.92%）. The incidence of postopera- tive complications was 12.77%. There was a significant difference in the incidences of postoperative complications between the EST,-LC group and the LCBDE＋ LC group （P〈0.05）. The operative time and the cost for hospital stay between the two groups were significantly different （P〈0.05）. After a follow-up of 3.2 years （mean, range 1-5 years）, there was no significant difference in long-term complications such as bile duct recurrent stones, duodenal papilla stenosis and eholangitis between the two groups （P〈0.05）. Conclusions LCBDE was a safe, efficacious and feasible minimal invasiveness treatment for cholecystocholedocholithiasis. Primary closure of common bile duct in selected eases brought additional benefits to the minimal invasive technique.