两种微创术式治疗胆囊结石合并胆总管结石的临床效果比较

发布时间：2018-07-05 10:42

本文选题：胆总管结石 + 腹腔镜胆囊切除术　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:比较分析腹腔镜胆总管探查术(LCBDE)联合腹腔镜胆囊切除术(LC)与内镜逆行胰胆管造影(ERCP)/内镜下括约肌切开术(EST)联合LC治疗胆囊结石合并胆总管结石的临床疗效。方法:回顾性分析新疆医科大学第二附属医院2013年12月~2016年12月资料完整的进行微创手术治疗胆囊结石合并胆总管结石的患者共87例,其中36例行LCBDE+LC手术治疗,51例行ERCP/EST+LC手术治疗,对两种治疗方法的手术成功率、中转开腹率、手术时间、术后肛门排气时间、住院时间、住院费用、术后早期并发症等临床资料进行比较,计量资料2组间比较采用t检验;计数资料2组间比较采用2?检验。结果:LCBDE+LC组手术成功率91.67%(33/36),中转开腹率8.35%(3/36),术后并发胆漏3例。ERCP/EST+LC手术成功率92.16%(47/51)、中转开腹率7.84%(4/51),术后并发胰腺炎9例、出血2例。比较两组手术成功率、中转开腹率差异无统计学意义(P0.05)。ERCP/EST+LC组术后急性胰腺炎的发生率高于LC+LCBDE组,差异有统计学意义(P0.05)。而术后出血、胆漏的发生率两组相比差异无统计学意义(P0.05)。LCBDE+LC组在手术时间、住院时间、住院费用等方面低于ERCP/EST+LC组,且差异具有统计学意义(P值均0.05)。结论:LCBDE+LC和ERCP/EST+LC均是治疗胆囊结石合并胆总管结石的有效微创疗法,LCBDE+LC组更具有手术时间短、住院时间短且住院费用低等优点,因此对于乳头功能良好经济困难的病人,应首选LCBDE+LC。但是总体应根据患者的不同情况,结合术者的技术和条件,合理的选择微创治疗方案。
[Abstract]:Objective: to compare the clinical effects of laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) and endoscopic retrograde cholangiopancreatography (ERCP) / endoscopic sphincterotomy (EST) in the treatment of cholecystolithiasis with choledocholithiasis. Methods: 87 cases of cholecystolithiasis complicated with choledocholithiasis were retrospectively analyzed in the second affiliated Hospital of Xinjiang Medical University from December 2013 to December 2016. Among them, 36 cases were treated with LCBDE LC and 51 cases were treated with ERCP / EST LC. The successful rate of operation, the rate of conversion to laparotomy, the time of operation, the time of anal exhaust after operation, the cost of hospitalization, and so on. The clinical data such as early postoperative complications were compared, the measurement data were compared by t test between two groups, and the count data between two groups were compared by 2? Examination. Results the operative success rate was 91.67% (33 / 36), the conversion rate was 8.35% (3 / 36), the success rate was 92.16% (47 / 51), the conversion rate was 7.84% (4 / 51), 9 cases were complicated with pancreatitis and 2 cases were bleeding. There was no significant difference in the conversion rate between the two groups (P0.05). The incidence of acute pancreatitis in ERCP / EST LC group was higher than that in LC LCBDE group (P0.05). There was no significant difference in the incidence of postoperative bleeding and bile leakage between the two groups (P0.05) .LCBDE LC group was lower than ERCP / EST LC group in operation time, hospitalization cost, and the difference was statistically significant (P 0.05). Conclusion both the% LCBDE LC and ERCP / EST LC are effective minimally invasive therapy for cholecystolithiasis complicated with choledocholithiasis. The LCBDE LC group has the advantages of shorter operation time, shorter hospitalization time and lower hospitalization cost. LCBDE LC. However, according to the different conditions of the patients, combined with the technique and conditions of the operator, the minimally invasive treatment should be reasonably selected.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.42

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