两种不同方法治疗胆囊结石并胆总管结石的临床效果对比分析

Comparison and Analysis of the Clinical Effect of Two Different Methods in the Treatment of Cholecystolithiasis and Choledocholithiasis

目的分析胆囊结石并胆总管结石治疗中应用腹腔镜胆囊切除术联合腹腔镜胆总管切开胆道镜探查取石术与内镜逆行胰胆管造影/内镜下括约肌切开取石术联合腹腔镜胆囊切除术的效果比较。方法方便选取该院2015年12月—2017年12月期间收治的86例胆囊结石并胆总管结石患者作为该次研究对象,按照治疗方法的不同对患者进行分组,LCBDE组与ERCP/EST组各43例,对比分析两组患者的住院时间、结石清除率以及胆总管直径,并比较两组的并发症发生率。结果LCBDE组手术成功率为90.69%,一次成功率100.00%,患者手术后恢复良好,结石清除率为100.00%,无复发无结石残留;ERCP/EST组手术成功率为86.05%,一次成功率78.38%,结石的清除率为95.35%(41/43),有2例患者手术后发现胆总管残留结石,再次治疗后,未见结石残留和复发(χ^2=0.4526、7.0261、0.8821、0.0000,P=0.5010、0.0080、0.3476、1.0000)。结论腹腔镜胆囊切除术联合腹腔镜胆总管切开胆道镜探查取石术与内镜逆行胰胆管造影/内镜下括约肌切开取石术联合腹腔镜胆囊切除术治疗胆囊结石并胆总管结石的效果显著,LCBDE联合腹腔镜胆囊切除术治疗的住院时间较少,且对于结石大小、数量没有限制,因此,临床中可以将腹腔镜胆囊切除术联合腹腔镜胆总管切开胆道镜探查取石术作为首选治疗方案。

Objective To analyze and compare the effect of two treatments of gallbladder stones and common bile duct stones.One treatment is laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration and choledochoscopy for endoscopic retrograde cholangiopancreatography.The other treatment is endoscopic sphincter incision combined with laparoscopic cholecystectomy.Methods A total of 86 cases of patients with gallbladder and common bile duct stones admitted to our hospital from December 2015 to December 2017 were convenient selected as the research objects.They were divided according to the different methods of treatment for the patient group.There were 43 cases in LCBDE group and 43 cases in ERCP/EST group.Hospital time,stone clearance rate,common bile duct diameter,and the incidence of complications of the two groups were compared.Results The success rate of operation in the LCBDE group was 90.69%,and the success rate of one operation was 100.00%.The patients recovered well after the operation,and the stone clearance rate was 100.00%.In the ERCP/EST group,the success rate of surgery was 86.05%,the first success rate was 78.38%,and the stone clearance rate was 95.35%(41/43).There were 2 patients with common bile duct residual stones found after surgery,and no stone residue or recurrence was found after retreatment(χ^2=0.452 6,7.026 1,0.882 1,0.000 0,P=0.501 0,0.008 0,0.347 6,1.000 0).Conclusion In the treatment of gallbladder and common bile duct stones,the two methods are effective.Hospital stay of LCBDE combined treatment of laparoscopic cholecystectomy is less,and it has no limit to the number and size of the stones.Therefore,Clinically,laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration and choledochoscopy for stone removal is the preferred treatment option.