两种不同术式治疗胆囊结石合并胆总管结石临床疗效对比分析

Comparison of clinical efficacy between two different surgical methods in treatment of cholecystolithiasis complicated with choledocholithiasis

目的对比传统开腹胆总管切开取石+胆囊切除术与经十二指肠镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)+内镜乳头括约肌切开取石术(endoscopic sphincterotomy,EST)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并胆总管结石临床疗效。方法回顾性分析2016-09～2017-09在该院接受治疗的88例胆囊结石合并胆总管结石患者的基本资料。将上述患者分为开腹组(开腹胆总管切开取石+胆囊切除术,44例)和ERCP+EST+LC组(44例)。比较两组患者的一般临床资料、手术时间、住院时间、住院费用、术前术后肝功能及术后并发症情况。结果两组术前谷丙转氨酶(ALT)、谷草转氨酶(AST)方面比较差异无统计学意义(P> 0. 05),而在手术时间、住院时间、住院费用、术后ALT、术后AST、术后总并发症发生率方面比较差异有统计学意义(P <0. 05)。结论 ERCP+EST+LC组治疗胆囊结石合并胆总管结石总体优于传统开腹胆总管切开取石+胆囊切除术,且手术时间及住院时间短,住院费用少,术后肝功能损伤小,安全性较高,值得推广。

Objective To compare the clinical efficacy between traditional cholecystectomy＋choledocholithotomy and endoscopic retrograde cholangio-pancreatography（ERCP）＋endoscopic sphincterotomy（EST） ＋laparoscopic cholecystectomy（LC） in treatment of cholecystolithiasis complicated with choledocholithiasis. Methods The basic data of 88 cases of cholecystolithiasis complicated with choledocholithiasis treated in our hospital from September 2016 to September 2017 were analyzed retrospectively. The patients were divided into open cholecystectomy group （ n = 44） and ERCP＋EST＋LC group（ n =44）. The general clinical data, operation time, hospitalization time, hospitalization costs, preoperative and postoperative liver function and postoperative complications were compared between the two groups. Results There were no significant differences in preoperative AST and preoperative ALT between the two groups（ P 〉0.05）, but there were significant differences in the operative time, hospitalization time, hospitalization costs, postoperative ALT and AST, and total preoperative complication rate between the two groups（ P 〈0.05）. Conclusion ERCP＋EST＋LC is superior to the traditional open choledocholithotomy in the treatment of cholecystolithiasis complicated with choledocholithiasis.