目的 比较开腹胆总管切开取石术与内镜下十二指肠乳头括约肌切开取石术(EST)两者治疗胆总管结石的疗效与费用。方法 收集北京友谊医院及北京积水潭医院2002年至2009年符合入选条件（年龄在20～75岁之间，术前经影像学检查证实为单纯胆总管结石，既往无胆道手术及EST病史，无严重全身合并症）的胆总管结石病例共177例，按其治疗方式分为开腹手术组和EST组。其中开腹手术组62例，EST组11 5例。比较两组患者性别组成、年龄、ASA分级、术前有无症状及症状持续时间、术前有无合并症，以上指标差异均无统计学意义。统计两组患者手术时间、出血量、取出结石的情况、术后恢复排气时间及腹痛持续时间、术后并发症的情况、住院时间及费用、残余结石发生率，对统计结果进行比较。结果开腹组手术时间为50～300 min(M=110)、出血量10～300 ml(M=60)、术后恢复排气时间24～96 h(M=48)、腹痛持续时间0～96 h（M=48）、住院时间8～70 d(M=21)、围手术期高淀粉酶血症发生率8.1％、手术费546～2498元(M=1503.2)；EST组手术时间为10～120 min(M=25)、出血量2～40 ml(M=10)、术后恢复排气时间1～48 h(M=3)、腹痛持续时间0～144 h(M=0)、住院时间5～56 d(M=17)、围手术期高淀粉酶血症发生率40％、手术费2028～5728元(M=2028)。以上差异均有统计学意义。结论EST手术时间短，出血量少，术后恢复排气时间短，腹痛持续时间短，住院时间短；但围手术期高淀粉酶血症发生率及手术费高于开腹手术。%Objective To compare the efficacy and health economics between open choledocholithotomy and endoscopic sphincterotomy (EST) these two operations on patients with choledocholithiasis. Methods 177 patients (aged 20-75 yrs, with simple choledocholithiasis on medical imaging,who had not been treated with either biliary tract surgery or EST, and had no severe complications)were treated electively at the Beijing Friendly Hospital and Beijing Jishuitan Hospital from 2002 to 2009. These patients were divided into two groups according to the treatment they received: open operation (n=62), or EST (n=115). There was no significant difference in sex, age, ASA class,symptoms before operation, and complications before operation between the 2 groups. The following data were compared: operation time, blood loss, size and number of stone, duration of postoperative ileus, duration of abdominal pain, incidence of postoperative complications, duration of hospitalization, cost of hospitalization and operation, and incidence of residual stones. Results For the open operation group, the operation time was 50-300 min (M=110), the blood loss was 10-300 ml (M=60), the duration of post-operative ileus was 24-96 h(M=48), the duration of abdominal pain was 0-96 h(M=48), the duration of hospitalization was 8-70 d(M=21), the duration of hyperamylasemia after operation was 8.1％ and the cost for operation was 546-2498 yuan (M=1503. 2). For the EST group, the operation time was 10-120 min (M=25), the blood loss was 2-40 ml (M=10),the duration of post-operative ileus was 1-48 h (M=3), the duration of abdominal pain was 0-144 h (M-0), the period of hospitalization was 5-56 d (M=17), the duration of hyperamylasemia after operation was 40％ and the cost for operation was 2028-5728 yuan (M=2028). There were significant differences in every aspect between these 2 groups of patients. Conclusions EST has a significantly shorter operation time, less blood loss, shorter duration of postoperative ileus, shorter duration of abdominal pain, shorter duration of hospitalization. However, EST had a significantly higher incidence of hyperamylasemia after operation and the cost was higher than open operation.
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