经十二指肠镜括约肌切开术后选择腹腔镜胆囊切除术的手术时机探讨

Operation timing of laparoscopic cholecystectomy after endoscopic sphincterotomy

目的 探讨经十二指肠镜括约肌切开术（EST）后选择腹腔镜胆囊切除术（LC）的手术时机.方法 胆囊结石合并胆总管结石患者240例按随机数字表法分为三组,均行EST联合LC,每组80例,分别于EST术后3d（A组）,7d（B组）,30d（C组）行LC,并对比各组术中和术后相关临床资料情况.结果 B组LC手术时间（52.5±6.4） min,明显较A组（35.8±5.7） min、C组（34.6±2.6） min延长,差异有统计学意义（P＜0.01）;B组中转开腹率10.0％（8/80）,较A组1.3％（1/80）、C组1.3％（1/80）明显增高,差异有统计学意义（P＜0.05）;B组术中出血量（51.7土4.8）ml,较A组（27.9±6.4） ml、C组（28.2±3.6） ml明显增多,差异有统计学意义（P＜0.01）.C组的住院总费用（15 361.2±1007.8）元,较A组（10 085.1±695.4）元、B组（10632.4±855.9）元明显增加,差异有统计学意义（P＜0.01）.结论 EST术后3d行LC可降低手术难度与中转开腹率,缩短手术时间,手术安全有效,优势明显.

Objective To investigate the operation timing of laparoscopic cholecystectomy （LC）after endoscopic sphincterotomy （EST）.Methods A total of 240 patients with cholecystolithiasis and choledocholithiasis received EST combined with LC.They were divided into 3 groups by random digits table method with 80 cases each：3 days after EST（group A）,7 days after EST（group B）,and 30 days after EST （group C）.Intraoperative and postoperative clinical data were compared among three groups.Results The operation time of LC in group B [（52.5 ± 6.4） min] was longer than that in group A and group C [（35.8 ± 5.7）,（34.6 ± 2.6） min],and there was significant difference （P ＜ 0.01）.The intraoperative conversion rate in group B [10.0 ％ （8/80）] was higher than that in group A and group C [1.3 ％ （1/80）,1.3 ％ （1/80）],and there was significant difference （P ＜ 0.05）.The amount of bleeding in group B [（51.7 ± 4.8） ml] was larger than that in group A and group C [（27.9 ± 6.4）,（28.2 ± 3.6） ml],and there was significant difference （P ＜ 0.01）.The cost of hospitalization in group C [（15 361.2 ± 1 007.8） yuan] was more than that in group A and group B [（10 085.1 ± 695.4）,（10 632.4 ± 855.9） yuan],and there was significant difference （P＜ 0.01）.Conclusion LC performed 3 days after EST can reduce the operation difficulty and conversion rate,and shorten the operation time,and this modality is safe and effective.