腹腔镜和内窥镜治疗胆总管结石的疗效对比研究

摘要

Objective:To investigate the clinical therapeutic effects of laparoscopy and endoscopy on treat‐ment of choledocholithiasis ,and provide basic data for the clinical surgical options .Methods:196 cases of patients with choledocholithiasis for elective hepatobiliary surgery surgical treatment were selected from March 2010 to April 2012 .All the cases were randomly divided into laparoscopic group and endoscopic group .Patients in laparoscopic group underwent laparoscopic common bile duct exploration plus cholecystectomy ,while in endoscopic group under‐went Endoscopic duodenal lithotomy .The operative time ,blood loss ,postoperative pain duration ,exhaust time , hospital stay ,as well as residual stone rate and postoperative complications in the two groups were compared .And long‐term complications in patients of the two groups were following‐up .Results:The operative time ,blood loss , postoperative pain duration ,exhaust time and hospital stay in laparoscopic group were less than the endoscopic group ,the differences were statistically significant (P<0 .05) .The rate of postoperative residual stones in laparo‐scopic group was 20 .0% ,which was further below than that of endoscopic group (P< 0 .05) .The postoperative complication rate in laparoscopic group was 3 .1% ,further below the 11 .2% of the endoscope group ,the difference was statistically significant (P<0 .05) .After 1‐year follow‐up ,Forward stone recurrence and reflux cholangitis re‐currence in laparoscopic group were lower than endoscopic group ,the differences were all statistically significant (P<0 .05) .Conclusions:Laparoscopic treatment for choledocholithiasis in patients had a better short‐term and long‐term efficacy ,can be used as the preferred method of minimally invasive treatment of choledocholithiasis .But for patients with the risk factors of complex abdominal surgery history , biliary pancreatitis and acute suppurative cholangitis ,endoscopic treatment had the advantages .%目的：探讨腹腔镜和内窥镜在治疗胆总管结石中的临床疗效。方法：择期行胆总管结石手术治疗的患者196例，随机分为腹腔镜组和内窥镜组。腹腔镜组行腹腔镜胆总管探查术，内窥镜组行内窥镜下十二指肠乳头切开术。比较两组患者手术时间、术中出血量、术后疼痛持续时间、排气时间、住院时间，以及结石残留和术后并发症情况，并随访观察患者远期并发症发生情况。结果：腹腔镜组患者手术时间、术中出血量、术后疼痛持续时间、排气时间和住院时间均少于内窥镜组，差异均具有统计学意义（P＜0．05）；腹腔镜组患者术后结石残留率为2．0％，远低于内窥镜组（P＜0．05），术后并发症发生率为3．1％，远低于内窥镜组的11．2％，差异具有统计学意义（ P＜0．05）；随访1年，腹腔镜组患者远期结石复发和反流性胆管炎发生率均低于内窥镜组，差异均具有统计学意义（P＜0．05）。结论：腹腔镜用于胆总管结石患者治疗具有较好的近期和远期疗效，可以作为微创治疗胆总管结石的首选方法；但对于具有上腹部复杂手术史、胆源性胰腺炎和急性化脓性胆管炎等高危因素的患者，内窥镜治疗更具优势。