胆囊结石合并胆总管结石治疗方法的比较

Comparison of Three Treatment Methods for Cholecystolithiasis with Commom Bile Duct Stones

目的 3种不同方式治疗胆囊结石合并胆总管结石的临床报告,评估其疗效及安全性.方法纳入2012年5月至2015年5月于昆明医科大学附属第二医院肝胆胰外科一病行手术治疗的胆囊结石合并胆总管结石患者180例,将其随机平均分为3组:A组60例患者一期行经十二指肠镜切开Oddi括约肌取石术(endoscopic sphincterotomy,EST),二期行腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC);B组60患者行腹腔镜下胆囊切除术(LC)+腹腔镜下胆道探查术(laparoscopic common bile duct exploration,LCBDE)+T管引流术;C组60例患者行传统的开腹胆囊切除术(open cholecystectomy,OC)+胆道探查术(open common bile duct exploration,OCBDE)+T管引流术.结果 A组中53例患者顺利实施手术,剩余7例患者中一期取石失败者5例,2例行LC+LCBDE,3例最终行开腹手术;二期中转开腹者2例;B组57例顺利完成手术,3例中转开腹手术;C组全部顺利完成手术.3组中A组并发症最多(P<0.05)如胰腺炎、胆瘘、出血,B组总住院时间最短(P<0.05),并发症发生率比A组低(P<0.05),与B组无明显统计学差异(P>0.05),B组手术时间最短(P<0.05);3组禁食时间结果无统计学差异(P>0.34).结论 3种治疗方式各有优劣,应根据具体情况,合理选择治疗方式.

Objective To summarize the clinical experience of three different treatments for gallbladder andcommon bile duct stones.Methods The clinical data of180cases of gallbladder stones combined with bile ductstones undergoing surgery from May2010to May2013were retrospectively analyzed.They were divided into threegroups,A group of60patients underwent a period of endoscopic sphincterotomy(EST),under the second phaseof laparoscopic cholecystectomy(LC);Group B60patients underwent laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration surgery(LCBDE)+T tube drainage;Group C60patients underwentconventional open cholecystectomy(OC)+bile duct exploration(OCBDE)+T tube drainage.Results A groupof53cases completed surgery successfully,5cases of remaining7patients failured in the first phase surgery,2cases of the5patients did LC+LCBDE,3of the5patients underwent conventional surgery.Two patients underwentthe conventional surgery in the second phase surgery.B group of57cases completed surgery successfully,threecases convert to open surgery.All of the group C completed the surgery successfully.Group A complication was themost in the three groups(P<0.05);group B had the shortest time of hospitalization(P<0.05),the complicationrate was lower than that in group A(P<0.05),the complication had no significant difference between A and B.(Pand group B>0.05),group B had shortest operation time(P<0.05);no statistically significant differences werefound among three groups in fasting time.Conclusion Three treatment methods have advantages as well asdisadvantages,a reasonable treatment should be selected according to the specific circumstances.