【摘要】 目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+胆总管探查术(common bile ductexploration,CBDE)与内镜下Oddi括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊疾病合并胆总管结石的临床效果及术式选择。方法:2001年4月～2007年12月我院采用微创外科技术治疗胆囊结石合并胆总管结石患者66例,其中LC+CBDE组48例,EST组18例,比较两组患者的手术时间、术中出血量、术后肠功能恢复时间、术后住院天数、住院总费用、并发症发生率、结石消除率等指标。结果:LC+CBDE组与EST组手术时间、术中出血量、术后肠功能恢复时间、结石消除率等指标差异无显著性(P>0.05),LC+CBDE组住院总天数、住院总费用、并发症发生率明显少于EST组(P<0.01)。结论:两种术式各有其适应证和优缺点,胆总管直径<1.0cm时以行EST取石术为宜,2～5d后再行LC。既往有胆道手术史者亦EST取石为宜。胆总管直径>1.0cm,尤其是并存二级胆管结石者(无胆管狭窄)则宜行LC+CBDE。更多还原

【Abstract】 Objective:To investigate the clinical effect of laparoscopic cholecystectomy(LC)+common bile duct exploration(CBDE) and endoscopic sphincterotomy(EST) combined with LC on treating the gallbladder disease with choledocholithiasis.Methods:The two minimally invasive procedures were carried out,which had sixty-six cases of cholecystolithiasis and common duct stones from Apr.2001 to Dec.2007.The patients were divided into two groups,with LC+CBDE group 48 cases and EST group 18 cases respectively.The clinical data were compared,such as operative time,blood loss,gastrointestinal function recovery time,postoperative hospitalization,cost,incidence of complication and clearance rate of stone.Results:There was no significant difference between the two groups about operative time,blood loss,gastrointestinal function recovery time and clearance rate of stone.(P>0.05).But there were significant differences in the postoperative hospitalization,cost,incidence of complication(P<0.01).Conclusions:There are respective indication,advantage and disadvantage between the two groups.If the common bile duct is less than 1.0cm in diameter,EST should be perfomed at first,followed with LC 2-5 days later.Otherwise,the better way is LC+CBDE,especially for secondary intrahepatic bile duct calculi(not complicated with stricture of bile duct).更多还原