LC术前及术后ERCP+EST治疗胆囊结石合并胆总管结石的效果比较

Efficacy comparison of ERCP plus EST before and after laparoscopic cholecystectomy in the treatment of cholelithiasis complicated with choledocholithiasis

目的探讨和比较腹腔镜胆囊切除术（LC）术前行经内镜逆行性胰胆管造影术（ERCP）和内镜下括约肌切开术（EST）与LC术后行ERCP和EST治疗胆囊结石合并胆总管结石的效果。方法选取2009年9月-2012年12月在山西医科大学第一附属医院及太钢总医院人院的胆囊结石合并胆总管结石行LC及ERCP＋EST的患者69例，其中LC术前行ERCP＋EST39例，LC术后行ERCP＋EST30例，比较两组的住院时间、并发症发生率、相关指标变化情况。结果术前组的住院时间短于术后组，差异有统计学意义（P〈0．05）。术前组的发热、急性胰腺炎发生率均低于术后组，差异有统计学意义（P〈0．05）；两组的出血、穿孔发生率比较差异无统计学意义（P〉0．05）。术前组的白细胞升高、高淀粉酶血症发生率均低于术后组，差异有统计学意义（P〈0．05）；两组的总胆红素值下降、ALT值下降发生率比较差异无统计学意义（P〉0．05）。结论LC术前行ERCP＋EST具有并发症少、住院时间短等优点，对治疗胆囊结石合并胆总管结石具有广阔的应用前景，值得临床推广应用。

Objective To explore and compare the efficacy of endoscopic retrograde cholangiopancreatography（ERCP） plus endoscopic sphincterotomy（EST）before and after laparoscopie cholecystectomy（LC）in the treatment of eholelithiasis complicated with choledocholithiasis. Methods 69 cases of patients with eholelithiasis complicated with choledoeholithiasis in the First Affiliated Hospital of Shanxi Medical University and the General Hospital of TISCO from September 2009 to December 2012 were selected and received LC and ERCP plus EST.39 patients received ERCP plus EST before LC and 30 patients received ERCP plus EST after LC.Hospitalization time,incidence rate of complication and the relevant index change in two groups was compared respectively. Results Hospitalization time in preoperative group was shorter than that in postoperative group,with statistical difference （P〈0.05）.The incidence rate of fever and acute panereatitis in preoperative group was lower than that in postoperative group respectively,with statistical difference（P〈O.O5）.The incidence rate of bleeding and perforation in two groups was compared respectively,with no statistical difference（P〉0.05）.The incidence rate of increase leukocytes and hyperamylasemia in preoperative group was lower than that in postoperative group respectively,with statistical difference（P〈0.05）.The incidence rate of total bilirubin value falls and ALT value decline in two groups was compared respectively,with no statistical difference （P〉0.05）. Conclusion ERCP plus EST carried out before LC has advantages of less complication and shorter hospitalization time,and has a wide prospect of application in the treatment of cholelithiasis complicated with choledoeholithiasis,which is worthy of clinical promotion and application.