LCBD联合腹腔镜与LC联合十二指肠镜疗效对比分析

Comparative study of clinical efficiency between LCBDE plus choledochoscope and LC plus duodenoscope

目的比较腹腔镜下胆总管切开取石术(LCBDE)与LC联合内镜下Oddis括约肌切开术(endoscopic sphincterotomy,EST)或内镜下十二指肠球囊扩张术(EPBD)治疗胆囊结石合并肝外胆管结石的疗效。方法回顾性分析我院2011年1月至2017年5月行LCBDE治疗的48例胆总管结石患者临床资料,同期行LC+EST(或EPBD)治疗的43例胆总管结石患者临床资料作为对照。结果两组手术均无手术相关死亡发生。与LC+EST组相比,LCBDE组术后急性胰腺炎发生率、结石残留率、严重并发症、住院时间、住院费用、手术出血量均明显降低,差异有统计学意义(P<0.05)。结论腹腔镜与十二指肠镜各自有相应的适应症,十二指肠镜适用于结石直径小,胆总管扩张不明显,或有上腹部手术史的患者,而腹腔镜联合胆道镜更有住院时间短,费用低,出血少,术后严重并发症发生率低、结石残留率低的优势。

Objective To compare the clinical effects between 1 aparoscopic cholecystectomy （LC） plus laparoscopic common bile duct exploration （LCBDE） and endoscopic sphincterotomy （EST） or endoscopic papillary balloon dilation（EPBD） in the treat- ment of cholecysto-choledocholithiasis. Methods The retrospectively cohort study was adopt. The clinical data of 81 patients with cholecysto-cboledocholithiasis were selected from January 2011 to May 2017 for this study. Forty eight patients went LCBDE,43 others went EST or EPBD. Results The two groups have no mortality occurred post-operative. In compared with EST group ,The acute pan- creatitis occurrence rate, residual stones rate,postoperative hospital stay, the medical cost and post-operative complications in LCBDE group were much better , and there was significant difference between two group statistically （P 〈 0. 05）. Conclusion the LCBDE and EST each have their respective indications. The EST was suitable for patients with small diameter of calculi,the inconspicuous bile duct expansion or with upper abdominal surgery. However , LCBDE has the advantage of low hospitalization time, low cost, low bleeding, low incidence of serious complications after operation, and low residual stones.