腹腔镜术中括约肌切开术与腹腔镜胆总管探查术的比较分析

目的比较腹腔镜胆囊切除术（Lc）联合术中内镜括约肌切开术（intraoperative endoscopic sphincterotomy,IOEST）技术（LC—IOEST）与LC联合腹腔镜胆总管探查（laparoscopic common bile duct exploration,LCBDE）技术（LC-LCBDE）治疗胆囊结石合并肝外胆管结石疾病的临床疗效,探讨该疾病的最佳微创治疗方案。方法将术前经B超或MRCP确诊和术中胆道造影确诊的胆囊结石合并肝外胆管结石患者275例,随机分为LC-IOEST（129例）和LC—LCBDE（146例）两组,比较两组联合技术的手术时间、手术成功率、结石残留率、术后近期并发症、术后住院时间、医疗费用。结果两组联合技术的手术时间、手术成功率、结石残留率、术后近期并发症、术后住院时间、医疗费用相比,均无显著性差异。结论LC-IOEST和LC-LCBDE两组联合技术是治疗胆囊结石合并肝外胆管结石的微创手段,后者还可能避免EST的一些远期并发症。

Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and combined with laparoscopic common bile duct exploration in treatment of: cholelithiasis and calculus of common bile duct

OBJECTIVE: To explore the best mini-invasive treatment for cholelithiasis and calculus of common bile duct. METHODS: 275 patients diagnosed as with cholelithiasis and choledocholithiasis were divided randomly into 2 groups: laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOEST) and laparoscopic exploration of the common bile duct (LCBDE) LC- LCBDE group, n = 146), and LC combined with intraoperative endoscopic sphincterotomy (IOEST) (LC-IOEST group, n = 129). The surgical time, surgical successful rate, stone number, complication rate, residual common bile duct stone rate, postoperative hospital stay, and hospitalization cost were compared. RESULTS: No difference was found between these two groups in terms of the surgical time, surgical successful rate, the stone number, complication rate, residual common bile duct stone rate, postoperative hospital stay, and hospitalization cost. CONCLUSION: LC-IOEST and LC-LCBDE are both effective minimally invasive treatments for cholelithiasis and calculus of common bile duct.