三镜联合治疗胆囊结石合并胆总管结石临床疗效及预后分析

Clinical effect and prognosis analysis of laparoscopic cholecystectomy combined with cholangioscopy and duodenoscopy in treatment of gallbladder stones associated with choledocholithiasis

目的:比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查术(腹腔镜、胆管镜和十二指肠镜三镜联合治疗)与内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆总管结石老年病人(≥65岁)的临床疗效。方法:回顾性分析我院2018年3月至2019年6月收治的60例胆总管直径≥10 mm的胆囊结石合并胆总管结石的老年病人,其中35例行LC联合胆总管探查一期缝合胆总管支架置入,25例行EST+LC,比较两组治疗情况。结果:病人术后住院时间以及胰腺炎、胆道出血、肺部感染以及结石复发、胆道感染,两组差异均无统计学意义,但手术时间、住院费用、术后高淀粉酶血症等方面差异具有统计学意义。结论:对于胆囊结石合并胆总管结石的老年病人,可行LC、胆总管切开取石,并置入胆总管支架,胆总管一期缝合,疗效显著,优于EST+LC。

Objective To compare the clinical effects on elderly patients suffered from gallbladder stones associated with choledocholithiasis between the group of laparoscopic cholecystectomy(LC)with common bile duct exploration(LCBDE)using three scopys including laparoscopy,cholangioscopy and duodenoscopy and the group of endoscopic sphinc-terotomy(EST)with LC.Methods Sixty elderly patients more than 65 years with stones in gallbladder and common bile duct had common bile duct diameter 10 mm and more in our hospital between March 2018 and June 2019 and were ana-lyzed retrospectively.Thirty-five cases had LC and LCBDE with primary duct closure combined with biliary stent.Twentyfive cases were treated EST with LC.Clinical effects were compared between two groups.Results There was no significant difference in postoperative hospital stay,pancreatitis,biliary bleeding,pulmonary infection and stone recurrence,biliary tract infection between two groups.However,the differences were significant in operative time,hospital cost and postoper-ative hyperamylasemia between two groups.Conclusions The stones in gallbladder and common bile duct in elderly patients could be treated by LC,LCBDE and primary duct closure combined with biliary stent,which had better clinical ef-fects when compared to EST and LC.