两种微创治疗方案对老年胆囊结石合并胆总管结石的临床对照研究

Comparison of the therapeutic efficacy between laparoscopic cholecystectomy and open cholecystectomy for patients with acute cholecystolithiasis complicated with choledocholithiasis

目的:对术前内镜下Oddi括约肌切开取石术(endoscopic sphincterotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与经腹腔镜胆囊切除胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)这两种微创治疗方案进行比较性分析,探讨针对老年胆囊结石合并胆总管结石患者的合理、安全且行之有效的微创治疗方案。方法:回顾性分析我院肝胆外科2011年1月到2014年1月收治的232例老年胆囊结石合并胆总管结石患者的临床资料,随机分为两组。120例患者采用LC+LCBDE治疗,112例患者采用EST+LC治疗,比较两组患者手术总时间、住院费用、住院天数、结石残留率、手术成功率及并发症发生情况。结果:两组在术手术总成功率、结石清除率、中转开腹率、总体并发症发生率等方面的差异均无统计学意义,但LC+LCBDE组在单次治疗成功率高于EST+LC组;在手术时间、术后进食时间、总住院天数、住院费用、术后住院天数和术后高淀粉酶血症发生率显著低于EST+LC组,差异有统计学意义。结论:对于老年胆囊结石合并胆总管结石患者,两种手术方式都是安全有效的,对于适应症明确的患者,选择LCBDE是适宜的、安全的、可靠的。

Objective：Through comparison of pre-EST plus LC and LC-LCBDE, we tried to figure out the much more rational, safe, and effective management of concomitant cholecystolithiasis and choledocholithiasis in senile patients. Methods： A total of 232 patients were treated for cholecystolithiasis and choledocholithiasis in senile patients by LC＋LCBDE（120） and EST＋LC（112） from 2011 to 2014. The operation time, hospitalizations charge, hospital stay, the success of operation, the clearance rate of calculus, and occurrence of complications were compared between the two groups. Results： There were no statistical significances in the success of operation, the rate of conversion, and the clearance rate of calculus between two groups. According to the operation time, the feeding time, primary success rate, hospitalizations charge, overall hospital stay, postoperative hospital stay, and hyperamylasemia in LC＋LCBDE group were significantly lower than the EST＋LC group（P〈0.05）.