| 摘要: |
| 目的:根据胆囊结石合并肝外胆管结石的不同特征，选择开腹胆囊切除 +胆总管探查取石术( OC+OCBDE)、内镜下逆行胰胆管造影 +腹腔镜胆囊切除( ERCP+LC组)、腹腔镜联合胆道镜( LC+LCBDE)三种术式，评价治疗胆囊结石合并肝外胆管结石的疗效、安全性及应用价值。方法:回顾性分析 2015年 5月— 2018年 5月皖北煤电集团总医院肝胆外科收治的 125例胆囊结石合并肝外胆管结石患者临床资料，根据结石的特征如数量、大小、位置等选择不同的手术方式:OC+OCBDE组 43例，ERCP+LC组 43例，LC+LCBDE组 39例。比较三种术式手术时间、成功率、术后肛门排气时间、住院天数、住院费用、结石残留率及并发症发生率等指标的差异。结果:三组患者在性别、年龄、临床表现、结石残留率等指标上均无统计学差异( P>0.05)。在手术时间、手术成功率、术后肛门排气时间、住院天数、住院总费、术后胆漏等方面差异有统计学意义( P<0.05):在结石残留率方面差异无统计学意义 (P>0.05)。结论: OC+OCBDE、ERCP+LC、 LC+LCBDE三种术式均是治疗胆囊结石合并肝外胆管结石安全有效的方式， OC+OCBDE组是经典的传统术式，虽创伤大但可以作为后两种术式失败的有效补救方式；ERCP+LC组保持了胆管的完整性，LC+LCBDE组保护了 Oiddis括约肌的功能；因此术者应根据患者个体情况及自身技术和医院设备条件作合理选择。 |
| 关键词: 胆囊结石 肝外胆管结石 腹腔镜胆囊切除术 逆行胰胆管造影术 |
| DOI：10.3969/j.issn.1007-6948.2020.01.024 |
| 投稿时间：2019-03-02 |
| 基金项目:蚌埠医学院校级科研计划( 2017BYKY17189) |
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| Analysis of Three Surgical Methods for Cholecystolithiasis Complicated with Extrahepatic Bile Duct Stones |
| XU Ming-you,YANG Xian-fen,CHEN Xi-lan |
| Department of Hepatobiliary Surgery，Wanbei Coal and Electricity Group General Hospital The Third Af.liated Hospital of Bengbu Medical College, Suzhou 234000, China |
| Abstract: |
| Objective According to the different characteristics of cholecystolithiasis complicated with extrahepatic bile duct stones, open cholecystectomy+common bile duct exploration (OC+OCBDE), endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy (ERCP+LC) and laparoscopic combined choledochoscopy (LC+LCBDE) were selected to evaluate the efficacy, safety and application value of the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones. Methods From May 2015 to May 2018, the clinical data of 125 patients with cholecystolithiasis complicated with extrahepatic bile duct stones treated in the Department of Hepatobiliary Surgery, General Hospital of Anhui North Coal and Electricity Group were retrospectively analyzed. The operation time, success rate, postoperative anal exhaust time, hospitalization days, hospitalization costs, stone residue rate and complication rate were compared. Results There was no significant difference in gender, age, clinical manifestation and residual stone rate between the three groups (P> 0.05). There were signi.cant differences in operation time, operation success rate, postoperative anal exhaust time, hospitalization days, total hospitalization fee, postoperative bile leakage and so on (P<0.05). There was no signi.cant difference in residual stone rate (P>0.05). Conclusion The three types of cholecystolithiasis and extrahepatic bile duct stones are all safe and effective methods for treating gallstone and extrahepatic bile duct stones. Group OC+OCBDE is a classic traditional surgical method. Although it is very traumatic, it can be used as an effective remedy for the failure of the latter two types of operation. Group ERCP+LC holds the integrity of the bile duct, and group LC+LCBDE is guaranteed. The function of the sphincter of Oiddis is protected. The surgeon should make a reasonable choice according to the patient’s individual condition, his own technology and hospital equipment conditions. |
| Key words: Cholecystolithiasis extrahepatic bile duct calculi laparoscopic cholecystectomy endoscopic retrograde cholangiopancreatography |
