胆囊结石合并胆总管结石两种微创治疗方法的效果比较

目的比较腹腔镜胆囊切除联合腹腔镜胆总管探查胆道支架引流术(LC+LCBDE+支架)和内镜下括约肌切开取石术(EST)联合LC(即EST+LC)两种微创手术方式治疗胆囊结石合并胆总管结石的临床效果。方法回顾性分析宁夏回族自治区人民医院肝胆外科97例胆囊结石合并胆总管结石病人的临床资料,其中52例行LC+LCBDE+支架,45例行EST+LC,比较两组病人的手术时间、术中出血量、住院时间、住院费用及术后并发症发生率。结果LC+LCBDE+支架组病人的住院时间、住院费用、术后并发症发生率均低于EST+LC组,手术时间长于EST+LC组,差异均有统计学意义(均P<0.05),两组病人术中出血量比较,差异无统计学意义(P>0.05)。结论两种手术方式各具优势,LC+LCBDE+支架术比EST+LC治疗胆囊结石合并胆总管结石具有住院时间短、住院费用低、并发症发生率低等优点,但手术时间较长。

Comparison of two minimally invasive managements for cholecystolithiasis combined with choledocholithiasis

Objective To compare the clinical effect of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration for biliary stent drainage(LC+LCBDE+stent)compared with endoscopic sphincterotomy and lithotomy(EST)combined with laparoscopic cholecystectomy(EST+LC)in the treatment of cholecystolithiasis with common bile duct stones.Methods The clinical data of 97 patients with cholelithiasis and choledocholithiasis in hepatobiliary surgery of Ningxia Hui Autonomous Region People′s hospital were analyzed retrospectively.Among them,52 patients underwent(LC+LCBDE+stent)and 45 patients underwent(EST+LC).The operation time intraoperative bleeding,hospitalization time,hospitalization cost and postoperative complications of the two groups were compared.Results The length of stay,hospitalization cost and postoperative complications were lower in LC+LCBDE+stent group than in EST+LC group.The difference was statistically significant(P<0.05),the intraoperative bleeding volume of patients in LC+LCBDE+stent group was slightly more than that in EST+LC group,and the difference was not statistically significant(P>0.05).Conclusion Compared with EST+LC,LC+LCBDE+stent has the advantages of short length of stay,low hospitalization cost and low complication rate,but the operation time is longer.