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胆囊结石合并胆总管结石治疗方法的比较
钟仕杰
(昆明医科大学附属第二医院肝胆胰外科一病区,云南 昆明 650101)
摘要:
[摘要]目的 3种不同方式治疗胆囊结石合并胆总管结石的临床报告,评估其疗效及安全性.方法 纳入2012年5月至2015年5月于昆明医科大学附属第二医院肝胆胰外科一病行手术治疗的胆囊结石合并胆总管结石患者180例,将其随机平均分为3组:A组60例患者一期行经十二指肠镜切开Oddi括约肌取石术(endoscopic sphincterotomy,EST),二期行腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC);B组60患者行腹腔镜下胆囊切除术(LC)+腹腔镜下胆道探查术(laparoscopic common bile duct exploration,LCBDE)+T管引流术;C组60例患者行传统的开腹胆囊切除术(open cholecystectomy,OC)+胆道探查术(open common bile duct exploration,OCBDE)+T管引流术.结果 A组中53例患者顺利实施手术,剩余7例患者中一期取石失败者5例,2例行LC+LCBDE,3例最终行开腹手术;二期中转开腹者2例;B组57例顺利完成手术,3例中转开腹手术;C组全部顺利完成手术.3组中A组并发症最多(P<0.05)如胰腺炎、胆瘘、出血,B组总住院时间最短(P<0.05),并发症发生率比A组低(P<0.05),与B组无明显统计学差异(P>0.05),B组手术时间最短(P<0.05);3组禁食时间结果无统计学差异(P>0.34).结论 3种治疗方式各有优劣,应根据具体情况,合理选择治疗方式.
关键词:  [关键词]胆囊结石  胆总管结石  腹腔镜  胆道探查术
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基金项目:[基金项目]国家自然科学基金资助项目(81460132);云南省科技厅-昆明医科大学应用基础研究联合专项基金资助助项目(2013FB161);云南省医疗卫生单位内设机构项目(2014NS061)
Comparison of Three Treatment Methods for Cholecystolithiasis with Commom Bile Duct Stones
ZHONG Shi-jie
(Dept. of Hepato-billiary Surgery,Second Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650000,China)
Abstract:
[Abstract]Objective To summarize the clinical experience of three different treatments for gallbladder and common bile duct stones. Methods The clinical data of 180 cases of gallbladder stones combined with bile duct stones undergoing surgery from May 2010 to May 2013 were retrospectively analyzed. They were divided into three groups, A group of 60 patients underwent a period of endoscopic sphincterotomy(EST),under the second phase of laparoscopic cholecystectomy(LC);Group B 60 patients underwent laparoscopic cholecystectomy(LC)+ laparoscopic common bile duct exploration surgery(LCBDE)+ T tube drainage;Group C 60 patients underwent conventional open cholecystectomy(OC)+ bile duct exploration(OCBDE)+ T tube drainage. Results A group of 53 cases completed surgery successfully,5 cases of remaining 7 patients failured in the first phase surgery,2 cases of the 5 patients did LC + LCBDE,3 of the 5 patients underwent conventional surgery. Two patients underwent the conventional surgery in the second phase surgery. B group of 57 cases completed surgery successfully,three cases convert to open surgery. All of the group C completed the surgery successfully. Group A complication was the most in the three groups(P<0.05);group B had the shortest time of hospitalization(P<0.05),the complication rate was lower than that in group A(P<0.05),the complication had no significant difference between A and B.(Pand group B > 0.05),group B had shortest operation time(P<0.05);no statistically significant differences were found among three groups in fasting time. Conclusion Three treatment methods have advantages as well as disadvantages, a reasonable treatment should be selected according to the specific circumstances.
Key words:  [Key words]Gallbladder stones  Choledocholithiasis  Laparoscopic cholecystectomy  Laparoscopic common bile duct exploration  Bile duct exploration surgery