肝内外胆管结石取石术与胰胆管逆行造影术治疗胆管结石的临床效果比较

Comparison of the clinical effect of intrahepatic and extrahepatic bile duct stone and retrograde contrast of the pancreatic duct in the treatment of bile duct stones

目的探讨肝内外胆管结石取石术与胰胆管逆行造影术治疗胆管结石的临床效果。方法选取80例胆管结石患者,运用随机数表法分为肝内外胆管结石取石术治疗组和胰胆管逆行造影术治疗组,每组40例。随访12个月,观察2组患者手术指标,并发症情况及其他指标。结果胰胆管逆行造影术治疗组的手术时间、术中出血量、术后恢复时间、住院总费用和住院时间明显优于肝内外胆管结石取石术治疗组差异有统计学意义(P<0.05);胰胆管逆行造影术治疗组的结石残留率、手术成功率、近期结石复发率明显优于肝内外胆管结石取石术治疗组,差异有统计学意义(P<0.05);胰胆管逆行造影术治疗组的并发症发生率(10.0%)明显少于肝内外胆管结石取石术治疗组(40.0%),差异有统计学意义(P<0.05);胰胆管逆行造影术治疗组的不良反应1级(80.0%)明显高于肝内外胆管结石取石术治疗组(60.0%),差异有统计学意义(P<0.05)。结论采用胰胆管逆行造影术治疗胆管结石患者的碎石成功率比较高,安全有效。

Objective To study the clinical effect of the treatment of intrahepatic and extrahepatic bile duct stone by stone removal and endoscopic retrograde cholangiopancreatography. Methods 80 patients with bile duct stones were selected and randomly di- vided into the treatment group of intrahepatic and extrahepatic bile duct stone and the treatment group of endoscopic retrograde cholangio- pancreatography（ n = 40 cases）. After treatment, the follow - up was 12 months. The operation indexes, complications and other indexes of the two groups were observed. Results The operational time,intraoperative bleeding volume, postoperative recovery time, total hospitali- zation expenses and hospitalization time of retrograde cholangiopancreatography treatment group was significantly better than that of intra- hepatic and extrahepatic bile duct stones treated group ,with statistical significance（ P 〈 0.05 ）. The rate of residual stone surgery, recur- rence rate of pancreatic duct in the retrograde cholangiopancreatography treatment group were significantly better than that extrahepatic bile duct stones treated group,with statistical significance （P 〈0.05 ）. The complications incidence of pancreatic duct retrograde cholan- giopancreatography treatment group （ 10% ） was significantly less than that of intrahepatic and extrahepatic bile duct stones treated group （ 40% ） ,with statistical significance （ P 〈 0.05）. The adverse reactions of the 1 level （80%） of pancreatic duct retrograde cholangiopan- creatography treatment group was significantly higher than that of intrahepatic and extrahepatic bile duct stones treated group （60%）. There was statistical significance （P 〈 0.05）. Conclusion The successful rate of pancreatic duct retrograde cholangiopancreatography in the treatment of patients with bile duct stones is high, safe and effective.