ERCP+EST与LCBDE+CBDE联合LC治疗老年胆囊结石合并胆总管结石的疗效观察
|
摘要
目的观察内镜逆行胰胆管造影(ERCP)+内镜十二指肠乳头括约肌切开术(EST)与腹腔镜胆总管切开探查术(LCBDE)+胆总管一期缝合术(CBDE)联合腹腔镜胆囊切除术(LC)治疗老年胆囊结石合并胆总管结石的疗效。方法回顾性分析我院自2014年1月~2017年9月间收治的胆囊结石合并胆总管结石患者的临床资料,按随机、平衡、对照原则分别筛选ERCP+EST+LC治疗患者40例作为观察组,另选取LCBDE+CBDE+LC治疗患者40例作为对照组,对比两组手术时间、术中出血、术中开腹比例及结石残余比例及术后肝功能指标,并统计并发症发生率及术后通气通便时间、住院天数、住院费用。结果两组手术时间、术中出血、术中中断开腹比例、结石残余比例、术后肝功能指标、并发症发生率、术后通气通便时间、住院天数、住院费用等指标比较差异均无统计学意义。结论 ERCP+EST或LCBDE+CBDE联合LC治疗胆囊结石合并胆总管结石均能取得满意疗效,但在临床选择上还需个体化原则使患者受益最大化。
Objective To observe the curative effect of endoscopic retrograde cholangiopancreatography( ERCP) + endoscopic sphincterotomy( EST) and laparoscopic common bile duct exploration( LCBDE) + common bile duct suture( CBDE) combined with laparoscopic cholecystectomy( LC) in the treatment of elderly patients with gallstone and choledocholithiasis. Methods The clinical data of patients with gallstone and choledocholithiasis who were treated in the hospital from January 2014 to September2017 were retrospectively analyzed. 40 patients treated by ERCP + EST + LC were included in the observation group and another 40 patients treated by LCBDE + CBDE + LC were included in the control group. The operative time,intraoperative blood loss,ratio of open operation,rate of residual stones and postoperative liver function indexes were compared between the two groups. The incidence of complications,postoperative ventilation and laxative time,hospital stay and hospitalization expenses were statistically analyzed. Results There was no significant difference between the two groups in operative time,intraoperative blood loss,ratio of open operation,rate of residual stones,postoperative liver function indexes,the incidence of complications,postoperative ventilation and laxative time,hospital stay or hospitalization expenses. Conclusion ERCP + EST or LCBDE + CBDE combined with LC can achieve satisfying results in treating gallstone with choledocholithiasis. The appropriate operation should be chosen according to the patient's actual condition.
Objective To observe the curative effect of endoscopic retrograde cholangiopancreatography( ERCP) + endoscopic sphincterotomy( EST) and laparoscopic common bile duct exploration( LCBDE) + common bile duct suture( CBDE) combined with laparoscopic cholecystectomy( LC) in the treatment of elderly patients with gallstone and choledocholithiasis. Methods The clinical data of patients with gallstone and choledocholithiasis who were treated in the hospital from January 2014 to September2017 were retrospectively analyzed. 40 patients treated by ERCP + EST + LC were included in the observation group and another 40 patients treated by LCBDE + CBDE + LC were included in the control group. The operative time,intraoperative blood loss,ratio of open operation,rate of residual stones and postoperative liver function indexes were compared between the two groups. The incidence of complications,postoperative ventilation and laxative time,hospital stay and hospitalization expenses were statistically analyzed. Results There was no significant difference between the two groups in operative time,intraoperative blood loss,ratio of open operation,rate of residual stones,postoperative liver function indexes,the incidence of complications,postoperative ventilation and laxative time,hospital stay or hospitalization expenses. Conclusion ERCP + EST or LCBDE + CBDE combined with LC can achieve satisfying results in treating gallstone with choledocholithiasis. The appropriate operation should be chosen according to the patient's actual condition.
引文
1周利国,唐才喜,周红兵.腹腔镜内窥镜治疗胆囊结石合并胆总管结石两种术式的临床分析.中国继续医学教育,2016,15(32):679-681.
2 张敬坡,冯雷,张传宝,等.“三镜”联合治疗胆囊合并胆总管结石75例临床分析.肝胆外科杂志,2015,23(1):27-29.
3 汤厚阔,全竹富.ERCP联合LC治疗胆囊结石合并胆总管结石的临床分析.肝胆外科杂志,2016,24(4):273-275.
4 蔡宇,何彦安.胆囊结石合并胆总管结石患者行腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发危险因素分析.肝胆外科杂志,2016,24(3):203-205.
5 张宗明,苑海明,张翀.双镜联合同期治疗胆囊结石合并胆总管结石的策略.中华消化外科杂志,2015,14(4):280-283.
6 何兴图,范存斌.胆石症防治指南.上海.上海普及出版社,2004:67-72.
7 菅志远,沈先锋,黄林生,等.三种微创方式治疗胆囊结石合并胆总管结石的临床疗效分析.中国普通外科杂志,2015,24(2):275-279.
8 李宇,郝杰,孙昊,等.一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较.中国普通外科杂志,2016,25(2):202-208.
9 陈淦,曹葆强,龚仁华,等.ERCP、EST联合LC治疗胆囊结石合并胆总管结石的临床分析.腹腔镜外科杂志,2015,20(6):448-450.
10 蒋亚新,季德刚,马宁,等.两种微创术式治疗老年胆囊结石合并胆总管结石的临床对比.中国普通外科杂志,2017,26(2):139-144.
11 王卫军,王天游,钱建清.ERCP联合腹腔镜治疗胆囊结石合并胆总管结石临床分析.实用医学杂志,2015,31(4):680-681.
12 代俭华,刘丹峰,陈龙江,等.ERCP+LC与LC+LCBDE治疗胆囊结石合并胆总管结石的疗效比较.肝胆胰外科杂志,2017,29(5):377-380.
13 王春丽.LC术前行ERCP+EST治疗高龄胆囊结石合并胆总管结石患者的近期疗效.检验医学与临床,2017,14(12):1815-1817.
14 黄建峰,翟东升,黄强.ERCP联合内镜下十二指肠乳头括约肌切开术治疗胆囊结石合并胆总管结石的临床分析.实用临床医药杂志,2015,19(23):72-74.
15 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.肝胆胰外科杂志,2016,28(6):448-453.
2 张敬坡,冯雷,张传宝,等.“三镜”联合治疗胆囊合并胆总管结石75例临床分析.肝胆外科杂志,2015,23(1):27-29.
3 汤厚阔,全竹富.ERCP联合LC治疗胆囊结石合并胆总管结石的临床分析.肝胆外科杂志,2016,24(4):273-275.
4 蔡宇,何彦安.胆囊结石合并胆总管结石患者行腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发危险因素分析.肝胆外科杂志,2016,24(3):203-205.
5 张宗明,苑海明,张翀.双镜联合同期治疗胆囊结石合并胆总管结石的策略.中华消化外科杂志,2015,14(4):280-283.
6 何兴图,范存斌.胆石症防治指南.上海.上海普及出版社,2004:67-72.
7 菅志远,沈先锋,黄林生,等.三种微创方式治疗胆囊结石合并胆总管结石的临床疗效分析.中国普通外科杂志,2015,24(2):275-279.
8 李宇,郝杰,孙昊,等.一期腹腔镜胆囊切除联合胆总管探查取石与分期内镜取石和腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的比较.中国普通外科杂志,2016,25(2):202-208.
9 陈淦,曹葆强,龚仁华,等.ERCP、EST联合LC治疗胆囊结石合并胆总管结石的临床分析.腹腔镜外科杂志,2015,20(6):448-450.
10 蒋亚新,季德刚,马宁,等.两种微创术式治疗老年胆囊结石合并胆总管结石的临床对比.中国普通外科杂志,2017,26(2):139-144.
11 王卫军,王天游,钱建清.ERCP联合腹腔镜治疗胆囊结石合并胆总管结石临床分析.实用医学杂志,2015,31(4):680-681.
12 代俭华,刘丹峰,陈龙江,等.ERCP+LC与LC+LCBDE治疗胆囊结石合并胆总管结石的疗效比较.肝胆胰外科杂志,2017,29(5):377-380.
13 王春丽.LC术前行ERCP+EST治疗高龄胆囊结石合并胆总管结石患者的近期疗效.检验医学与临床,2017,14(12):1815-1817.
14 黄建峰,翟东升,黄强.ERCP联合内镜下十二指肠乳头括约肌切开术治疗胆囊结石合并胆总管结石的临床分析.实用临床医药杂志,2015,19(23):72-74.
15 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.肝胆胰外科杂志,2016,28(6):448-453.