腹腔镜联合内镜治疗胆囊结石合并肝外胆管结石的疗效观察

摘要

目的 探讨腹腔镜联合内镜治疗胆囊结石合并肝外胆管结石的可行性与安全性.方法 82例胆囊结石合并肝外胆管结石患者随机分为治疗组和对照组,每组各41例.治疗组采用内镜逆行胆胰管造影(ERCP)、内镜括约肌切开术(EST)取石及腹腔镜胆囊切除(LC),对照组采用开腹胆囊切除、胆总管探查及T管引流术.比较分析两组手术成功率、术后并发症发生、手术时间、术后进食时间及住院时间等指标.结果 治疗组和对照组手术成功率分别为95.1％和92.7％,差异无统计学意义(P＞0.05);治疗组手术时间、术中出血量、术后排气时间、术后进食时间及住院时间显著优于对照组,差异均有统计学意义(P＜0.05);两组术后并发症的发生率差异无统计学意义(P＞0.05).结论 腹腔镜联合内镜治疗胆囊结石合并肝外胆总管结石安全、可行、疗效确切,是一种理想的的微创术式.%Objective To explore feasibility and safety of endoscopy combined with and laparoscopy in the treatment of cholecystoiithiasis and extrahepalic bile duct cholelithiasis. Methods A total of 82 patients with cholecystoiithiasis and eitrahepatic bile duct cholelithiasis were randomly divided into two groups, including 41 cases of treatment group, 41 cases of control group. The treatment group was treated with endoscopic retrograde cholangiopancreatography( ERCP) , endoscopic sphincterotomy( EST) and laparoscopic cholecystectomy ( LC). The control group was treated with traditional operation. The success rate of operation, complications, operation time, feeding time after operation, stay - in - hospital time after operation were compared. Results The success rate of operation in treatment group was 95.1 % and 92.7 % in control group, and the difference was not significant (P > 0.05). The operation time, blood loss, feeding time after operation, stay - in - hospital time after operation in treatment group were significantly better than those in control group ( P < 0. 05 ). There was no significant difference between the two groups in the rate of complication(P <0.05). Conclusion It is a safe, effective and feasible microtranma surgery for treating cholecysloiithiasis and extrahepatic bile duct cholelithiasis with endoscopy combined with and lap-aroscopy.