三镜联合手术方案治疗胆道结石患者的临床疗效及预后情况分析

Clinical Effect of Operation Scheme of Combined Three Endoscopes for Extrahepatic Bile Duct Calculus

目的:研究三镜联合手术方案治疗肝外胆道结石患者的临床疗效及预后情况分析。方法:选择从1999年5月至2014年5月在我院接受治疗的肝外胆道结石患者300例进行回顾性分析。所有患者均接受三镜联合手术方案治疗,290例患者成功接受手术,其中先行经内镜十二指肠乳头造影/切开术(ERCP/EST),然后行腹腔镜胆囊切除术(LC)(先ERCP/EST后LC组)103例,先行LC,然后行ERCP/EST(先LC后ERCP/EST组)73例,同时行LC和ERCP/EST(LC与ERCP/EST同时组)114例。分析患者整体手术情况,对比各组手术相关指标、结石取出情况及并发症。结果:300例患者中,10例因结石过大、缩窄乳头炎、出血及怀疑胆囊癌因素中转开腹。三组手术时间、术中出血量、住院时间与住院费用指标相比,差异均无统计学意义(均P>0.05),成功取出结石率及并发症发生率三组相比,差异均无统计学意义(均P>0.05)。结论:通过不同手术顺序的三镜联合手术方案治疗肝外胆道结石,临床疗效及患者的预后情况均较好,值得在临床推广应用。

Objective： To study the clinical effect and prognosis of combined three endoscopes in the treatment of extrahepatic bile duct calculus. Methods： A total of 300 patients with extrahepatic bile duct calculus（EBDC）, who were treated in Chongqing Third People’s Hospital from May 1999 to May 2014, were selected and retrospectively analyzed. All the patients with EBDC were treated with combined three endoscopes, there were 290 cases of successful surgery, among which 103 patients first underwent endoscopic retrograde cholangio-pancreatography/endoscopic sphincterotomy（ERCP/EST） and then laparoscopic cholecystectomy（LC）（ group I）; 73 patients first LC and then ERCP/EST（group II）; 114 patients, LC together with ERCP/EST（group III）. The surgery status, the related surgery indexes, calculus removal, and complication of the three groups were analyzed and compared. Results： Among the 300 patients, there were 10 patients were transfered to laparotomy surgery due to the too big calculus, constrictive nipple papillitis, bleeding and suspected gallbladder carcinoma. There were no significant differences in surgery time and intraoperative bleeding loss, hospitalization time and hospitalization expenses, successful calculus removal rate, and incidence of complication among the three groups（P〉0.05）. Conclusion：The operation scheme of combined three endoscopes for extrahepatic bile duct calculus has better clinical effects and prognosis, which is worthy popularizing in the clinical application.