摘要
目的 探讨腹腔镜与内镜治疗胆总管结石的安全性有效性及适应证。方法 回顾性对比分析1997年7月至2006年6月腹腔镜胆总管切开术及内镜括约肌切开术治疗胆总管结石213例（腹腔镜组122例，内镜组91例）的临床资料。结果 腹腔镜组与内镜组相比手术成功率（96．7％vs．91．2％）及结石清除率（99．2％vs．94．0％）两组相似，近期并发症率（3．4％vs．13．3％，χ^2=6．864，P=0．009）较低；腹腔镜组的平均住院日（z=-2．713，P=0．007）及住院费用（z=-3．156，P=0．002）较高，主要原因是部分病例合并急性梗阻性胆管炎及胆源性胰腺炎预置鼻胆管引流控制感染，以及部分病例行胆总管T管引流等。内镜组发生重症胰腺炎3例（3．6％），其中死亡1例（1．2％）。结论 腹腔镜胆总管切开术保持Oddi括约肌完整，并发症较少、较轻，是治疗胆总管结石较为安全有效的方法。腹腔镜胆总管切开术适用于合并胆囊结石及胆总管扩张，急性梗阻性胆管炎及胆源性胰腺炎得到有效控制，全身情况好、能耐受麻醉手术者；内镜括约肌切开术适用于合并胆总管下段狭窄及结石嵌顿、急性梗阻性胆管炎、胆源性胰腺炎、全身情况差不能耐受麻醉手术的老年患者。
Objective To explore the safety, result and indications of laparoscopic and endoscopic procedures for the management of choledocholithiasis. Methods Of 213 cases with cholidocholithiasis, 122 underwent laparoscopic choledochotomy and 91 underwent endoscopic sphincterotomy in our hospital between July 1997 and June 2006. Clinical data especially treatment outcomes of beth groups were analyzed retrospectively. Results Laparoscopic group compared with endoscopic group： success rate （96.7% vs. 91.2% ） and stone clearance rate （99. 2% vs. 94. 0% ） was comparable, early postoperative complication rate （3.4% vs. 13.3%, χ^2 =6.864, P=0.009） was less, average hospital stay （z= -2.713, P= 0. 007） and cost （z = -3. 156, P = 0. 002 ） was higher, Three cases suffered from severe post-EST pancreatitis （3.6%） with 1 death （ 1.2% ）. Conclusions Laparoscopic choledochotomy appears to be safer and more effective for cholidocholithiasis, with intact Oddi＇ sphincter and fewer or less serious complications compared with endoscopic sphincterotomy. Laparoscopic choledochotomy is indicated in patients with coexistent gallbladder stone and common bile duct stone with dilated common duct in cases with well-controlled acute obstructive cholangitis and biliary panceatitis. Endoscopic sphincterotomy is indicated in elderly patients with ampullary stenosis and stone incarceration especially when coexistent with acute obstructive cholangitis, biliary panceatitis, poor general conditions.
出处
《中华普通外科杂志》
CSCD
北大核心
2007年第6期410-412,共3页
Chinese Journal of General Surgery
作者简介
通信作者：许卓明。E-mail：jzmxu@163．com
