内镜联合腹腔镜与传统开腹手术治疗胆囊结石合并胆总管结石的临床比较

Clinical comparison between endoscopy combined with laparoscopy and traditional open surgery in the treatment of cholecystolithiasis and choledocholithiasis

目的:探讨内镜联合腹腔镜治疗胆囊结石合并胆总管结石的临床疗效。方法:回顾分析2010年1月至2012年12月106例胆囊结石合并胆总管结石患者的临床资料,其中内镜联合腹腔镜手术(联合组)58例,开腹胆囊切除+胆总管探查术(开腹组)48例,对比两组患者术后恢复情况。结果:联合组术后通气时间、住院时间、住院费用显著优于开腹组(P<0.05);联合组术后5例发生并发症,开腹组发生12例,差异有统计学意义(χ2=5.232,P=0.022)。结论:内镜联合腹腔镜手术治疗胆囊结石合并胆总管结石安全、有效,具有患者创伤小、康复快的优点;但术者应准确掌握适应证、合理安排内镜下十二指肠乳头切开取石术与腹腔镜胆囊切除术的间隔时间。

Objective：To explore the clinical efficacy of endoscopic sphincterotomy combined with laparoscopic cholecystecto-my in treatment of cholecystolithiasis and choledoeholithiasis. Methods：The clinical data of 106 patients with choleeystolithiasis and choledocholithiasis from Jan. 2010 to Dec. 2012 were retrospectively analyzed. They were divided into endoscopy combined with laparos-copy group （ n = 58 ） and open surgery group （ n = 48 ）. The postoperative recovery was compared. Results： Postoperative exhaust time, hospital stay, hospitalization expenses in the combined group were significantly better than those in the open group （ P 〈 0.05 ）. 5 cases in the combined group and 12 cases in the open group developed complications （X^2 = 5. 232, P = 0. 022 ）. Conclusions： Endoscopic sphincterotomy combined with laparoscopie choleeystectomy is a safe and effective method with little injury and quick recovery in the treatment of cholecystolithiasis and choledoeholithiasis. Surgeons should accurately master indications, legitimately choose the interval between endoscopic sphincterotomy and laparoscopic eholecystectomy.