胆囊结石合并胆管结石两种微创方法的比较

目的：比较腹腔镜胆囊切除术（LC）＋腹腔镜胆总管探查术（LCDE）和括约肌切开取石术（EST）＋LC两种方法处理胆囊结石合并胆管结石的优缺点,探索胆囊结石合并胆管结石的最佳处理方法。方法：回顾行分析我院2007年9月至2009年6月采用微创处理27例胆囊结石合并胆管结石病例,其中LC＋LCDE 15例,EST＋LC 12例。比较其手术时间、围手术期并发症、住院时间及术后结石复发及发生胆管炎等。结果：27例手术均获成功,结石全部取净,无中转开腹。LC＋EST组手术时间短,术后恢复快,但住院时间长,围手术期并发症多。术后随访3月,两组均无结石复发及发生胆管炎等。结论：微创方法治疗胆囊结石合并胆管结石具有创伤小、效果好、恢复快等优点,对于具体病例应根据胆管扩张情况、结石多少及位置以及十二指肠乳头功能决定具体的微创方式。

Comparison of Two Laparoscopic Treatments for Cholecystolithiasis Complicated with Secondary Common Bile Duct Stones

Objective：To investigate the efficacy of two strategies in the treatment of cholecystolithiasis complicated with secondary common bile duct stones：laparoscopic cholecystectomy with transcytic common bile duct exploration（LC ＋ LCDE）,or laparoscopic cholecystectomy after endoscopic sphincterotomy（EST ＋ LC）.Methods：Twenty-seven patients clinical data（15 cases were treated with LC＋LCDE and 12 cases with EST＋LC） were analyzed retrospectively and the operation time,complications,average hospital stay and cost as well as residual stones were observed.Results：The operations succeeded and no residual stones happened in both groups.The mean operation time in EST＋LC group was shorter than that in LC＋LCDE,but the mean hospital stay was longer in EST＋LC group than in LC＋LCDE group.In addition,there was no significant difference in severe complications between both groups after 3-month followup.Conclusion：Both strategies are effective and safe for cholecystolithiasis complicated with secondary common bile duct stones and individual principle must be obeyed in clinic based on actual condition of patients.