腹腔镜联合十二指肠镜不同序贯次序治疗胆囊结石并胆总管结石效果对比研究

发布时间：2018-03-22 18:29

本文选题：肝外胆管结石　切入点：十二指肠镜乳头括约肌切开术　出处：《中国内镜杂志》2015年01期 　论文类型：期刊论文

【摘要】：目的观察并比较腹腔镜联合十二指肠镜不同序贯次序治疗胆囊合并胆总管结石的手术效果。方法2010年3月-2012年10的124例胆囊结石合并胆总管结石患者为研究对象,按照随机数字表分为A(67例)、B(57例)两组,A组患者采取十二指肠镜乳头括约肌切开术(EST)+择期腹腔镜胆囊切除术(LC)手术方案,B组予LC+EST方案,对比两组手术成功率、手术并发症、住院时间及术后1年远期并发症发生情况。结果A、B两组双镜联合手术成功率、术中转开腹手术率、手术并发症发生率、平均住院时间、1年随访期内并发症发生率分别为89.6%vs84.2%、3.0%vs12.3%、11.3%vs16.0%、(9.3±2.5)d vs(7.8±2.7)d、6.7%vs6.0%,其中两组平均住院时间差异有显著性(u=3.000,P=0.003)。结论两种序贯手术方案治疗胆囊结石合并胆总管结石各有利弊,EST+LC方案优点主要体现在EST术前可探明胆囊三角解剖结构,降低盲目行LC而转开腹手术的几率;LC+EST方案主要优点是可借助一次麻醉完成手术,缩短住院时间。
[Abstract]:Objective to observe and compare the effect of laparoscopic combined duodenoscopy in the treatment of cholecystolithiasis with choledocholithiasis. Methods 124 patients with cholecystolithiasis complicated with choledocholithiasis from March 2010 to October 2012 were studied. According to the random number table, 67 patients with Amega were divided into two groups: group A and group B were treated with laparoscopic cholecystectomy with endoscopic sphincterotomy and laparoscopic cholecystectomy (group B). The success rate and complications of operation were compared between the two groups. Results the rate of success, the rate of conversion to laparotomy, the incidence of complications, and the rate of complications in group A and B were compared with those in group A and B, and the duration of hospitalization and long-term complications occurred 1 year after operation. The average length of hospitalization and the incidence of complications during the 1-year follow-up period were 89.6vs84.20.The incidences of complications were 89.6vs84.2and 3.0cm vs 12.3vs11.3vs16.00.It was 9.3 卤2.5d vs(7.8 卤2.7 days and 6.7VS6.0.The difference of average hospitalization time between the two groups was significant. Conclusion the two sequential surgical regimens for cholecystolithiasis with choledocholithiasis have their own advantages and disadvantages. The advantage of the case is that the anatomical structure of the triangle of gallbladder can be discovered before EST. The main advantage of LC EST scheme is that the operation can be completed by one anesthesia and the hospitalization time can be shortened.
【作者单位】：浙江省慈溪市人民医院外科;浙江大学医学院附属第二医院外科;
【分类号】：R657.42

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