ERCP/EST联合LC治疗胆总管结石合并胆囊结石的临床疗效

Clinical Effects of ERCP/EST Combined LC in the Treatment of Gallbladder Stones with Choledocholithiasis

目的探讨内镜逆行胰胆管造影术（endoscopic retrograde pancreatic angiography，ERCP）联合腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）治疗胆总管结石合并胆囊结石的临床疗效。方法选择笔者医院自2011年10月～2015年5月共收治112例胆总管结石合并胆囊结石的患者，其中73例行ERCP／EST＋LC（观察组），39例行外科开腹手术治疗（对照组）。比较两组手术的成功率、手术一般情况、术后并发症发生率、术后结石残留率及复发率等指标。结果观察组与对照组手术成功率比较，差异无统计学意义（94．5％VS97．4％，P〉0．05）。观察组患者肛门排气时间、住院时间、禁食天数均显著小于对照组（2．32±1．04天VS3．25±1．21天，11．05±3．10天VS18．15±6．84天，2．17±0．52天VS3．56±0．59天），差异有统计学意义（P〈0．05）；观察组并发症发生率显著低于对照组（7．50％VS27．50％），差异有统计学意义（P〈0．05）；观察组患者结石残留率及复发率均显著低于对照组（1．37％VS5．13％，9．59％VS15．38％），差异有统计学意义（P〈0．05）。结论ERCP／EST联合LC治疗胆总管结石合并胆囊结石具有良好的疗效，与传统开腹手术相比，具有创伤小、恢复快、术后并发症少、复发率低的优势。

Objective To explore the clinical effects of endoscopic retrograde pancreatic angiography（ERCP） combined laparoscop- ic choleeystectomy（LC） in the treatment of gallbladder stones with common bile duct calculi. Methods From oct 2011 to may 2015,112 patients with cholecystocholithiasis underwent either ERCP ＋ LC （ observation group, n= 73 ） or coventional surgery （ control group, n = 39）. The treatment success rate, the general status of patients, complications, and the rates of residual stones, and relapse were com- pared for two groups. Results There was no significant difference in the operative success rate between the two group （94.5% vs 97.4% ,P 〉 0.05 ）. The operative time, time to first exhaust, hospitalization time and time to first food for the observation group were sig- nificantly better than those for the control group （2.32 ±1.04days vs 3.25 ± 1.21days, 11.05±3.10days vs 18.15 ± 6.84days, 2.17 ±0. 52days vs 3.56 ± 0.59days, P 〈 O. 05 ）. The rate of complications for the observation group was significationly lower than for the control group（7.50% vs 27.50% , P 〈 0.05）. The rates of residual stones, and relapse for the observation group were also significantly lower than those for the control group（ 1.37% vs 5.13% ,9.59% vs 15.38% , P 〈 0.05）. Conclusion ERCP/EST combined LC is superior to conventional surgery in the treatment of gallbladder stones with eholedocholithiasis with regard to minimal surgical trauma, quicker re- covery, and lower rates of complication,relapse.