LC联合EST与LC联合LCBED治疗胆囊结石合并胆总管结石疗效对比

赵利锋，江奎，王钢，罗冬根

（陕西省宝鸡市中心医院肝胆胰脾外科，陕西 宝鸡，721008）

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摘要：

目的 探讨胆囊结石合并胆总管结石采用腹腔镜胆囊切除术（LC）联合乳头切开取石术（EST）与LC联合胆总管探查术 （LCBED）治疗的临床效果。方法 选取本院收治的胆囊结石合并胆总管结石患者339例，按照治疗方法的不同分为研究组 （n=156）与对照组（n=183），分别采用LC+EST、LC+LCBED治疗，对比两组临床疗效。结果 两组患者手术成功率、并发症发生率、结石残留发生率比较，差异不显著（P>0.05）；研究组手术时间、术中出血量优于对照组（P<0.05）；研究组术后肛门排气时间、住院时间明显短于对照组（P<0.05）。结论 在胆囊结石合并胆总管结石患者的治疗中，采用LC+EST与LC+LCBED治疗各有优缺点，可按照患者具体情况选择恰当手术方式。

关键词：胆囊结石；胆总管结石；腹腔镜胆囊切除术；乳头切开取石术；胆总管探查术

中图分类号：R657.4文献标志码：A文章编号：2096-1413(2017)15-0050-02

Clinical comparison of LC+EST and LC+LCBED in the treatment of gallstones and common bile duct stones
ZHAO Li-feng, JIANG Kui, WANG Gang, LUO Dong-gen
(Department of Hepatobiliary and Pancreatic Surgery, Baoji Central Hospital, Baoji 721008, China)

ABSTRACT: Objective To investigate the clinical effect of laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and LC combined with common bile duct exploration (LCBED) in the treatment of gallstones and common bile duct stones. Methods A total of 339 cases of patients with gallstones and common bile duct stones admitted in our hospital were selected as the study objects. All the patients were divided into study group (n=156) and control group (n=183). The study group received LC+EST, and the control group was treated with LC+LCBED, the clinical effects of the two groups were compared. Results There was no significant difference on operation success rate, incidence rate of complications and residual stone rate of the two groups (P>0.05). The operation time, bleeding loss of the study group were better than those of the control group (P<0.05). The postoperative anal exhaust time and hospitalization time of the study group were significantly shorter than those of the control group (P<0.05). Conclusion In the clinical treatment of gallstones and common bile duct stones, the treatment of LC+EST and LC+LCBED has their advantages and disadvantages. The appropriate surgical approach can be chosen according to the specific circumstances of patients.
KEYWORDS: gallbladder stone；common bile duct stone；laparoscopic cholecystectomy (LC)；endoscopic sphincterotomy (EST)；exploration of common bile duct (LCBED)

参考文献：
[1] 许斌,蒋琼,周璐,等.EST联合LC术治疗胆囊结石并胆总管结石临床疗效分析[J].中外医学研究,2015,13(35):38-39.
[2] 李建明,李伟,宋巍巍,等.内镜联合腹腔镜治疗胆囊结石并胆总管结石的临床研究[J].微创医学,2016,11(5):792-794.
[3] 陈楷.ERCP+EST+LC联合治疗胆囊并胆总管结石的效果评估[J].医学信息,2016,29(33):263-264.
[4] 汪海,王怀志,魏从光,等.腹腔镜胆囊切除术联合十二指肠镜下乳头切开术治疗胆石症合并胆总管末端狭窄或细径胆总管结石效果观察[J].解放军医药杂志,2015,27(8):68-71.
[5] 黄俊晓.EST 联合LC术式对胆囊结石合并胆总管结石的临床疗效分析[J].临床医学,2016,36(5):3-4.
[6] 贺永锋,杨小翠,杨成林,等.ERCP+EST联合LC与开腹手术治疗胆囊并胆总管结石比较[J].西南国防医药,2016,26(5):502-504.
[7] 马大喜,李可为,王坚,等.LC+LCBDE 和ERCP/EST+LC在胆囊合并胆总管结石中应用的随机对照研究[J].肝胆胰外科杂志,2016,28(6):448-453.
[8] 周国勤,刘彬,袁建军.EST联合LC治疗胆囊结石合并胆总管结石的效果分析[J].中国现代医生,2015,53(13):35-37.