胆石症专题研究(Monographic Study of Cholelithiasis)

腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石的临床对照研究

Published at: 2015年第24卷第8期

张智勇 1 , 杜立学 1 , 郑伟 1 , 李晖 1 , 张煜 1
1 陕西省人民医院 肝胆外科,陕西 西安 710068
通讯作者 立学 杜 Email: Lixuedu_xa@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.08.006
基金:

摘要

目的:比较腹腔镜胆总管探查术(LCBDE)与内镜下十二指肠乳头括约肌切开术(EST)治疗胆总管结石的临床效果。方法:回顾性分析2012 年11 月—2014 年3 月收治的210 例胆总管结石患者资料,按手术方式分为LCBDE 组(116 例)和EST 组(94 例),对比两组相关临床指标。结果: 两组手术成功率差异无统计学意义(99.1% vs. 95.74%,P=0.175),但LCBDE 组一期治愈率高于EST 组(97.4% vs. 90.4%,P=0.038);两组残余结石率、平均住院时间与住院费用均无统计学差异(均P>0.05),但EST 组一期治疗后9 例残余结石患者行第2 次EST 治疗,6 例残余结石患者行第3 次EST 治疗;首次EST 失败的患者,其住院时间与花费明显增加;LCBDE 组围手术期总并发症以及远期并发症发生率均明显低于EST 组(均P<0.05),差异主要来源于EST 相关并发症。结论:LCBDE 治疗胆总管结石一期治愈率高于EST,且并发症率低于EST 组,能保留十二指肠乳头括约肌的生理功能,可同时实施腹腔镜胆囊切除术处理胆囊病变。因此,在多数情况下,应首先考虑LCBDE。


Clinical comparative study of laparoscopic common bile duct exploration versus endoscopic sphincterotomy for choledocholithiasis

Abstract

Objective: To compare the clinical effects between laparoscopic common bile duct exploration (LCBDE) and endoscopic sphincterotomy (EST) for common bile duct stones. Methods: The data of 210 patients with common bile duct stones treated between November 2012 and March 2014 were retrospectively analyzed. The patients were divided into LCBDE group (n=116) and EST group (n=94) according to the procedure they received, and the main clinical variables between the two groups were compared. Results: The surgical success rate had no significant difference between the two groups (99.1% vs. 95.74, P=0.175), but the one-stage cure rate in LCBDE group was significantly higher than that in EST group (97.4% vs. 90.4%, P=0.038), and there was no significant difference in residual stone rate, and the average length of hospital stay and hospitalization costs between the two groups (all P>0.05), but in EST group, 9 cases underwent second EST, and 6 cases underwent third EST after the first-stage treatment due to residual stones, and the length of hospital stay and medical expenses were markedly increased in these cases with first treatment failure. The incidence of perioperative complications and long-term complications in LCBDE group was significantly lower than that in EST group (both P<0.05), due to the relatively high incidence of the EST-related complications of the latter. Conclusion: For common bile duct stones, the one-stage cure rate of LCBDE is higher than that of EST, with less incidence of complications and preservation of the function of the sphincter of Oddi. In addition, laparoscopic cholecystectomy can be simultaneously performed to solve the gallbladder problems during LCBDE. Thus, it should be considered as the first choice of option in most cases.


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引用

引用本文: 智勇 张, 立学 杜, 伟 郑, 晖 李, 煜 张. 腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石的临床对照研究[J]. 中国普通外科杂志, 2015, 24(8): 1088-1092.
Cite this article as: ZHANG Zhiyong, DU lixue, ZHENG Wei, LI Hui, ZHANG Yu . Clinical comparative study of laparoscopic common bile duct exploration versus endoscopic sphincterotomy for choledocholithiasis[J]. Chin J Gen Surg, 2015, 24(8): 1088-1092.