胆囊结石并胆总管结石三种疗法的远期并发症比较

Comparison of long-term complications of three different treatments for cholecystolithiasis with choledocholithiasis

目的比较胆囊结石并胆总管结石3种治疗方法的远期并发症,探讨合理可靠的治疗方法。方法回顾性分析2006年1月至2009年12月166例胆囊结石合并胆总管结石患者的临床资料,其中开腹胆囊切除+胆总管切开取石+T管引流术方案治疗74例(A组),内镜下Oddi括约肌切开取石+腹腔镜胆囊切除术方案治疗61例(B组),腹腔镜下胆囊切除+胆总管切开取石术方案治疗31例(C组)。比较3组患者的术后远期并发症。结果 166例患者平均随访时间18.5个月(12～48个月),出现远期并发症者有28例(16.86%)。其中:胆总管结石复发19例(11.4%),胆管炎17例(10.2%),胰腺炎3例(1.8%),乳头狭窄6例(3.6%),切口疝2例(1.2%)。B组的远期并发症和结石复发率显著高于其他两组。结论 3种术式各有其适应证和优缺点。应根据具体情况采用个体化的治疗方法。

Objective To explore rational and effective treatment strategies by comparing long-term complications of three different treatments for cholecystolithiasis with choledocholithiasis.Methods From Jan.2006 to Dec.2009,the clinical data of 166 cases of cholecystolithiasis with choledocholithiasis were analyzed retrospectively,among which 74 cases underwent OC＋OCHTD,61 cases underwent EST＋LC and 31 cases underwent LC＋LCBDE.The long-term complications of the three groups were compared.Results 166 patients were followed up for an average period of 18.5 months（12-48 months）.Late complications occurred in 28 patients（16.86%） including cholangitis in 17（10.2%）,acute pancreatitis in 3（1.8%）,duodenal papilla stenosis in 6（3.6%） and incisional hernia in 2（1.2%）.Recurrent choledocholithiasis was found in 19 patients（11.4%）.The rates of late complications and recurrent choledocholithiasis were significantly higher in group B than those in group A and group C.（P0.05）.Conclusion There are respective indications,advantages and disadvantages in three groups.The treatment for patients with simultaneous cholecystolithiasis and choledocholithiasis must be individualized.