十二指肠镜术后早期联合腹腔镜手术治疗胆囊结石合并胆总管结石的临床体会

Early laparoscopic operation after duodenoscopy in the treatment of cholecystolithiasis coexisting with choledocholithiasis

目的:总结十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石的临床经验,探讨十二指肠镜后早期行腹腔镜手术的优势。方法:为90例胆囊结石合并胆总管结石患者行十二指肠镜下Oddi括约肌切开取石术(endoscopic sphincteroto-my,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),并将其分为两组(n=45),A组于EST术后24～72 h内行LC;B组于EST术后3 d以上行LC。对比分析两组患者手术时间、全麻时间、出血量、中转率、并发症发生率、住院时间、住院费用等指标。结果:90例均成功施行EST,85例成功施行LC。A组LC手术时间明显缩短(P<0.05)、中转率低(P<0.05)、术后住院时间及总住院时间短(P<0.05)。结论:十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石安全、可行,成功率高,患者创伤小,并发症少;EST术后早期行腹腔镜手术优势明显。

Objective：To summarize the clinical experience of sequential duodenoscopic-laparoscopic treatment for patients with cholecystolithiasis and choledocholithiasis.To study the advantage of early laparoscopic operation after duodenoscopy.Methods：Clinical data of 90 patients of cholecystolithiasis coexisting with choledocholithiasis treated with laparoscopic cholecystectomy（LC） after endoscopic sphincterotomy（EST） from Aug.2010 to Jan.2012 were retrospectively reviewed.They were divided into two groups（n=45）,early LC was performed after EST in group A（24-72 h）,delayed LC was performed after EST（＆gt;72 h） in group B.The following indices of the 2 groups were comparatively analyzed：operative time,time of general anesthesia,blood loss,conversion rate,complication incidence,hospital stay and hospitalization cost.Results：There was no significant differences in diagnosis indices such as hemobilirubin,galactosylhydroxylysyl glucosyltransferase and ultrasonic sound.There was no significant difference between the demographics of the patients in both groups.The mean operation time,mean postoperative hospital stay,total hospital stay and conversion rate in group B were significantly higher than those of group A（P＆lt;0.05）.Conclusions：It is safe and feasible for duodenoscopy combined with laparoscopy in the treatment of cholecystolithiasis and choledocholithiasis.The advantages of this procedure include high achievement ratio,little trauma for patients and few complications.The superiority of early laparoscopic operation after EST is apparent.