LC＋EST一期治疗胆囊结石合并胆总管结石

One-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for the treatment of cholecysto-choledocolithiasis

目的评价腹腔镜胆囊切除术（1aparoendoscopy，LC）联合逆行胰胆管造影（ endoscopicretrograde cholangiopancreatography, ERCP）＋十二指肠乳头括约肌切开术 （ endoscopic sphincterotomy,EST）一期治疗胆囊结石及胆总管结石的安全性。方法63例患者分成2组，试验组31例，对照组32例，试验组在全麻下先行ERCP＋EST，取出胆总管结石，之后直接行腹腔镜下胆囊切除术；对照组先在全麻下行ERCP及EST，取出胆总管结石．3～5d后再于全麻下行腹腔镜胆囊切除术。结果结石清除率分别为96．9％和96．7％，术后肺部感染分别为7．1％（n=2）和16．1％（n=5）；平均住院时间（7．5±1．7）d和（12．6±2．5）d，试验组术后肺部感染和平均住院时间对照组明显减少（分别，=6．203，t=2．74，均P〈0．05）。结论Lc术中联合EST一期治疗胆囊结石合并胆总管结石，与先行EST，3～5d后再行腹腔镜胆囊切除术相比，一样安全、有效，并且肺部感染明显减少，平均住院时间显著缩短。

Objective To evaluate the safety and efficacy of one-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for the treatment of patients who have concurrent gallstones and CBD stones. Methods We conducted a prospective study from Mar 2008 to Nov 2011 in our department. A total of 63 consecutive patients of concurrent gallstones and CBD stones were included and divided into two groups： 31 patients in test group first underwent ERCP and EST to remove CBD stones, and then during the same general anesthesia underwent laparoseopic cholecystectomy （ LC ） ; while 32 patients in control group first underwent ERCP and ES, and then LC 3 - 5 days later. Results The stone clearance rate in test group and control group were 96. 9% and 96.7% （ P 〉 0. 05 ） , respectively. The postoperative lung infection rate in the test group and the control group were 7. 1% and 16. 1% （P 〈 0. 05 ） , respectively. The length of hospital stay （LOS） of the two groups was （7.5 ± 1.7） days and （ 12.6 ±2. 5） days, respectively （ P 〈 0. 05 ）. The total expense of hospitalization was ￥ （2 356± 126 ） and￥ （ 37 056 ± 152） , respectively （P 〈 0.05）. Conclusions One-stage laparoendoscopic management of patients with concurrent gallstones and CBD stones is safe, effective and more economic approach than two-stage treatment for patients suffering from concurrent gall stone and choledocholithiasis.