腹腔镜下胆总管切开术与经内镜括约肌切开术治疗胆总管结石313例

Laparoscopic common bile duct exploration vs. endoscopic sphincterotomy for the management of chole-docholithiasis in 313 cases

目的探讨腹腔镜下胆总管切开术（LCBDE）与经内镜括约肌切开术（EST）治疗胆总管结石的疗效及适应证。方法回顾性分析2005年1月至2011年12月行LCBDE与EST治疗胆总管结石313例（LCBDE组188例，EST组125例）的临床资料。结果LCBDE术、EST术的手术成功率分别为98．9％、92．8％，平均住院费用分别为1．3万元、1．4万元，近期并发症发生率分别为1．6％、9．6oA，平均住院日分别为13．5d、9．8d。结论两种术式各有优缺点及其适应证。胆总管直径〉1．0cm的多发或较大结石以及中青年患者应首选LCBDE术式；而胆总管直径〈1．0cm、胆总管中下段结石或老年胆石症病人宜采用EST术式。

Objective To explore the results and indications of laparoscopic common bile duct exploration （LEBDE） vs. endoscopic sphincterotomy （EST） procedures for the management of chole- docholithiasis. Methods Of 313 cases of choledocholithiasis, 188 underwent LEBDE, and 125 under- went EST in our hospital between Jan. 2005 and Dec. 2011. Clinical data especially for treatment out- comes of both groups were analyzed retrospectively. Results For LCBDE and EST, the operation success rate was 98. 9% and 92. 8%, The average cost was 13 000 and 14 000 Yuan RMB, the incidence of the early postoperative complication was 1.6% and 9. 6%, and the average hospital stay was 13. 5 days and 9. 8 days, respectively. Conclusion There are respective indications, advantages and disad- vantages for LCBDE vs. EST. LCBDE is the better choice for patients with a CBD〉 1.0 cmin diameter and multiple choledocholithiasis, especially in young and middle-aged people. Otherwise, the better way is EST for patients with a CBD 〉1.0 cm in diameter, stones impacted in the distal CBD, or old age.