腹腔镜联合胰十二指肠镜治疗胆囊结石伴胆总管结石效果观察

Effect of laparoscopy combined with pancreatic and duodenal endoscopy in the treatment of gallstone with common bile duct stones

目的探讨腹腔镜联合胰十二指肠镜治疗胆囊结石合并胆总管结石的效果。方法选择我院收治的100例胆囊结石伴胆总管结石患者,将其按照不同治疗方法分为治疗组和对照组,各50例。治疗组患者先于内镜下逆行胰胆管造影(ERCP)及内镜乳头括约肌切开取石术(EST)处理胆总管结石,后行腹腔镜胆囊切除术(LC)处理胆囊结石。对照组患者行传统胆囊切除胆总管切开取石T管引流术。对两组患者的手术时间、术中出血量、术后疼痛评分、术后排气时间及住院时间、并发症发生率等进行对比分析。结果两组患者的手术时间、术中出血量、术后疼痛评分、术后排气时间及住院时间比较,差异具有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论腹腔镜联合胰十二指肠镜治疗胆囊结石合并胆总管结石是一种安全有效的治疗方法,较传统胆囊切除胆总管切开取石T管引流术,具有手术时间短、术中出血少、术后疼痛轻、术后排气时间及住院时间短的优点,且并发症发生率并没有提高,同时避免了放置T管,提高了患者的生活质量,值得广泛推广。

Objective To explore the iherapeulic effecl of laparoscopy combined with pancrealic and duodenal endoscopy in lhe lrealmenl of gallslone wilh common bile duel slones. Methods One hundred cases of gallslone wilh common bile duel stones admitted in our hospilal were selected and randomly assigned lo treatment group and control group, with 50 cases in each group. The palienls in lhe lrealmenl group were treated wilh endoscopic retrograde cholangiopancreatography （ ERCP） and endoscopic sphincterotomy （ EST） lo lreal choledocholilhiasis, then accepted laparoscopic cholecystectomy （ LC） lo lreal gallslone. The control group were treated wilh choledocholilholomy and T lube drainage. The operation lime, blood loss, postoperative pain scores, postoperative exhaust lime and hospilal slay and incidence rale of complications were compared and analyzed between lhe lwo groups. Results The differences of operation lime, blood loss, postoperative pain scores, postoperative exhaust lime and hospilal slay between lhe lwo groups were significant （ P〈0.05）, and there was no significant difference in lhe incidence rale of complications （ P 〉0.05）. Conclusion For palienls wilh gall slone wilh common bile ducl slones, laparoscopy combined wilh pancrealic and duodenal endoscopy is safe and effective. Compared wilh lhe choledocholilholomy and T lube drainage, il has shorter operation lime, postoperative exhaust lime and hospilal slay, less bleeding, lighter postoperative pain, bul lhe incidence rale of complications won＇t increase. Al lhe same lime, il can avoide lhe troubles of placing T lube, and improve palienls＇ quality of life, which is worthy of extensive promotion.