微创式治疗胆囊结石并胆总管结石的临床研究

目的：探讨腹腔镜与十二指肠镜联合治疗胆囊结石合并胆总管结石的临床应用价值。方法：74例胆囊结合并胆总管结石患者随机分为EST＋LC组（44例）和OC＋OCHTD组（30例）,其中EST＋LC组行十二指肠镜Oddi括约肌切开术（EST）加腹腔镜下胆囊切除术（LC）,OC＋OCHTD组行开腹胆囊切除术（OC）加胆总管切开取石T管引流术（OCHTD）,比较两组手术过程、术后恢复、并发症情况等。结果：①EST＋LC组手术时间长于OC＋OCHTD组,切口长度与术中出血量少于OC＋OCHTD组（P〈0.01或0.05）。②EST＋LC组手术成功率90.91%,取石成功率100%,OC＋OCHTD组手术成功率100%,取石成功率93.33%,两组间差异无显著性（P〉0.05）。③EST＋LC组镇痛药使用率低于OC＋OCHTD组,术后引流时间、肠鸣音恢复时间、肛门排气时间和平均住院时间短于OC＋OCHTD组（P〈0.01或0.05）。④EST＋LC组与OC＋OCHTD组均并发症少,无结石复发。结论：十二指肠镜Oddi括约肌切开术联合加腹腔镜下胆囊切除术治疗胆囊结石和胆总管结石具有创伤小、恢复快、并发症少、住院时间短等优势,值得进一步临床推广。

Clinical Observation of Minimal Invasive Surgery for Cholecystolithiasis with Choledocholithiasis

Objective：To investigate the clinical value of laparoscopy combined with duodenoscope in treatment of cholecystolithiasis with choledocholithiasis.Methods：A total of 74 cases of cholecystolithiasis with choledocholithiasis were selected,44 cases in EST＋LC group were treated with endoscopic sphincterotomy and laparoscopic cholecystectomy,30 cases in OC＋OCHTD group with routine cholecystectomy and choledocholithotomy plus T-tube drainage by laparotomy.The operation procedure,postoperative recovery and complication were compared between the two groups.Results：① In EST＋LC group,operation time was longer than that in OC＋OCHTD group,but incision length and bleeding volume less than OC＋OCHTD group（P0.01 or 0.05）.② The operation succeed rate was respectively 90.91% and 100% in EST＋LC and OC＋OCHTD group,stone-free rate 100%（EST＋LC） and 93.33%（OC＋OCHTD）,there was no difference between the two groups（P0.05）.③ There was significantly difference between EST＋LC and OC＋OCHTD group in frequency of pain-killer use,duration of postoperative drainage,recovery of function of gastrointestinal tract,anal exsufflation and average hospital stay（P0.01 or 0.05）.④ Both EST＋LC and OC＋OCHTD group had no severe complications and recurrence of stone.Conclusion：Endoscopic sphincterotomy and laparoscopic cholecystectomy could be widely used in clinic for minimal invasion,.quick recovery,few complications and short hospital stay.