肝胆胰外科杂志2012，Vol.24Issue(3)：188-191,4.
腹腔镜胆总管探查术与内窥镜下括约肌切开术治疗胆总管结石的临床应用比较
Comparison of clinical application of laparoscopic common bile duct exploration and endoscopicsphincterotomy in the treatment of common bile duct stones
摘要
Abstract
Objective To compare the clinical effectiveness and complication of laparoscopic common bile duct exploration (LCBDE) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones, to probe the indication between two techniques and guide the reasonable clinical application. Methods Two hundred and two patients with common bile duct stones were divided into the LCBDE group (n =45) and EST group (n=157) according to the operation manner. The success rate of operation, cure rate of one stage operation, residual stone/lesion rate, complication rate, average hospital stav and expenses were evaluated. Results The success rates of operation were 97.8% (44/45) in LCBDE group and 98.7% (155/157) in EST group (P> 0.05), respectively. The recovery rate of one stage operation were 84.4% (38/45) and 45.2% (71/157) (P< 0.01), respectively. The main residual disease in LCBDE group was stone with the residual stone rate 15.6% (7/45); The main residual disease in EST group were unresected gallbladder and rest stones with the residue rate 54.8% (86/157) (P < 0.01). Postoperative complication in LCBDE group included 4 cases of bile leaks and 1 residual infection with complication rate 11.1%; and complication in EST group included 3 bile leaks, 4 hemorrhages, 32 hyperamylasemias(14 acute pancreatitis) and 15 acute cholangitis with complication rate 34.4% (P< 0.05).The average hospital stays in two group were (10.0 ± 2.8) and (9.4 ± 4.1)d (P > 0.05), respectively; and the total hospital charges were (17504 ± 4128) and (16453 ±3541) RMB (P> 0.05),respectively. Conclusion Both LCBDE and EST possess some advantages such as higher success rate and shorter hospital stay, but complication rate and residue disease rate of LCBDE are lower than those of EST; LCBDE mainly applies to the patients with gallbladder and CBD stone, especially patients with excellent Oddi sphincter function. EST mainly applies to the patients with simple CBD stone or cholangitis, especially aged and physically weak patients with had Oddi -phincter function or patients who underwent biliary surgical procedures or refuse to do operation again.关键词
胆总管结石/腹腔镜胆总管探查术/内窥镜下括约肌切开术Key words
common bile duct stones/ iaparoscopic common bile duct exploration/ endoscopic sphinc-terotomy分类
医药卫生引用本文复制引用
陈晓鹏,张卫东,王东,屠佳,田野,崔巍,韩真,袁鹤鸣,张国政..腹腔镜胆总管探查术与内窥镜下括约肌切开术治疗胆总管结石的临床应用比较[J].肝胆胰外科杂志,2012,24(3):188-191,4.基金项目
安徽省卫生厅医学科研课题资助项目(2010C073). （2010C073）
