内镜逆行胰胆管造影取石术与开腹手术治疗胆总管结石的疗效比较

Efficacy comparison between lithotripsy via endoscopic retrograde cholangiopancreatography and laparotomy in the treatment of choledocholithiasis

目的 探讨内镜逆行胰胆管造影（ERCP）取石术治疗胆总管结石的有效性和安全性.方法 选取2012年1月至2013年3月本院就诊的胆总管结石患者100例,按随机数字表分为治疗组（n=50）和对照组（n=50）,分别采用ERCP取石术和开腹手术进行治疗.比较两组患者的手术情况、手术费用和住院费用.术后2周,记录患者的临床疗效和术后并发症情况.术前和术后2周采用胃肠疾病生活质量指数（GIQLI）量表对患者的生活质量进行评价.结果 治疗组患者的手术时间、术中出血量、术后通气时间、切口疼痛时间及住院天数均少于对照组（均P＜0.05）.而两组患者的住院费用、结石未净的发生率、血清总胆红素（TBIL）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）水平差异均无统计学意义（均P＞0.05）.治疗组患者术后高淀粉酶血症的发生率高于对照组（P＜0.05）.治疗2周后随访显示,治疗组患者的自觉症状、心理情绪和生活质量总评分均显著高于对照组（均P＜0.05）.结论 ERCP取石术治疗胆总管结石的有效性和安全性较高.

Objective To explore the efficacy and safety of stone extraction via endoscopic retrograde cholangiopancreatography （ERCP） in the treatment of choledocholithiasis.Methods One hundred patients with choledocholithiasis admitted in our hospital from January 2012 to March 2013 were randomly divided into the treatment group （n=50） and the control group （n=50）,and treated by ERCP and laparotomy,respectively.The surgery condition,surgery cost and hospitalization expense were compared between two groups.Two weeks after operation,clinical efficacy and postoperative complications of the patients were recorded.The pre-operative and 2 weeks post-operative quality of life were evaluated by Gastrointestinal Quality of Life Index （GIQLI）.Results The operation time,intraoperative bleeding volume,duration of postoperative ventilation or incision pain,and hospital stay of treatment group were shorter than those of control group （all P＜0.05）.However,there were no statistical significances in hospitalization expense,incidence of uncleared stone,serum total bilirubin （TBIL）,aspartate aminotransferase （AST）,alanine aminotransferase （ALT） between two groups （all P＞0.05）.The incidence of postoperative hyperamylasemia in treatment group was higher than that in control group （P＜0.05）.The follow-up showed that the scores of subjective symptom,emotional state,and total scores of quality of life in treatment group were higher than those in control group 2 weeks after operation （all P＜0.05）.Conclusion Stone extraction via ERCP has higher efficacy and safety in the treatment of choledocholithiasis.