CAJ | 학술논문

目的探讨微创外科治疗胆总管结石(CBDS)的策略.方法回顾性分析2001年6月至2007年1月304例CBDS患者的临床资料.按手术方式不同分三组:十二指肠镜下乳头气囊扩张术加LC组(EPBD组)、十二指肠镜下乳头括约肌切开取石术加LC组(EST组)、腹腔镜联合纤维胆道镜胆总管切开探查术加LC组(LCBDE组).结果 304例中EPBD组35例,EST组138例,LCBDE组131例.三组的手术成功率、近期并发症发生率、残石率比较,差异无统计学意义(x2值分别为1.93、0.038和0.427,P>0.05);手术时间比较差异有统计学意义(F=17.941,P=0.000),LCBDE组优于另两组(EPBD-EST:P=0.122,EST-LCBDE:P=0.000,EPBD-LCBDE:P=0.020);住院时间相比差异有统计学意义(F=24.016,P=0.000),其中EPBD组最短(EPBD-EST:P=0.000,EST-LCBDE:P=0.198,EPBD-LCBDE:P=0.000).远期并发症:EPBD组结石复发2例(6.7%),胆管炎1例(3.3%),无乳头狭窄;LCBDE组结石复发7例(6.0%),胆管炎3例(2.6%),无乳头狭窄;EST组结石复发18例(15.8%)、乳头狭窄9例(7.9%)、胆管炎14例(12.3%);比较三组结石复发、胆管炎、乳头狭窄的发生率,差异有统计学意义(x2值分别为6.482、9.160和12.02,P<0.05),EST组高于EPBD组和LCBDE组.结论有适应证的胆总管结石可首选EPBD治疗,失败或无适应证者则选择LCBDE,EST仅适用于有严格适应证者.
목적 탐토미창외과치료담총관결석(CBDS)적책략.방법 회고성분석2001년6월지2007년1월304례CBDS환자적림상자료.안수술방식불동분삼조:십이지장경하유두기낭확장술가LC조(EPBD조)、십이지장경하유두괄약기절개취석술가LC조(EST조)、복강경연합섬유담도경담총관절개탐사술가LC조(LCBDE조).결과 304례중EPBD조35례,EST조138례,LCBDE조131례.삼조적수술성공솔、근기병발증발생솔、잔석솔비교,차이무통계학의의(x2치분별위1.93、0.038화0.427,P>0.05);수술시간비교차이유통계학의의(F=17.941,P=0.000),LCBDE조우우령량조(EPBD-EST:P=0.122,EST-LCBDE:P=0.000,EPBD-LCBDE:P=0.020);주원시간상비차이유통계학의의(F=24.016,P=0.000),기중EPBD조최단(EPBD-EST:P=0.000,EST-LCBDE:P=0.198,EPBD-LCBDE:P=0.000).원기병발증:EPBD조결석복발2례(6.7%),담관염1례(3.3%),무유두협착;LCBDE조결석복발7례(6.0%),담관염3례(2.6%),무유두협착;EST조결석복발18례(15.8%)、유두협착9례(7.9%)、담관염14례(12.3%);비교삼조결석복발、담관염、유두협착적발생솔,차이유통계학의의(x2치분별위6.482、9.160화12.02,P<0.05),EST조고우EPBD조화LCBDE조.결론 유괄응증적담총관결석가수선EPBD치료,실패혹무괄응증자칙선택LCBDE,EST부괄용우유엄격괄응증자.
Objective To investigate management strategy of minimally invasive surgery for common bile duct stones. Methods Three hundred and four cases of common bile duct stones were divided into 3 groups receiving respectively endoscopic papillary balloon delation plus laparoscopic cholecystectomy ( EPBD group, 35 cases ), endoscopic sphincterotomy plus LC ( EST group, 138 cases), and Laparoscopic common bile duct exploration plus LC (LCBDE group, 131 cases). Results There was no significant difference in treatment success rate, short-term complications and bile duct retained stones among these three group ( x2 = 1. 930, 0. 038, and 0. 427 respectively, P > 0. 05 ). There was significant difference among these three groups in operation time ( F = 17.941, P = 0. 000 ), and the operation time in LCBDE group was shorter than that in other two groups( EPBD-EST: P = 0. 122, EST-LCBDE:P = 0. 000, EPBD-LCBDE:P = 0. 020 ). There was significant difference among these three groups in postoperative hospital stay (F =24. 016,P =0. 000) ,and the postoperative hospital stay in EPBD group was shorter than that in other two groups ( EPBD-EST: P = 0. 000, EST-LCBDE : P = 0. 198, EPBD-LCBDE : P = 0. 000 ). In EPBD group,bile duct recurrent stones was found in 2 cases(6. 7% ) and cholangitis in 1 case(33% ) and no duodenal papilla stenosis was encountered; In LCBDE group, bile duct recurrent stones were found in 7 cases (6. 0% ), cholangitis in 3 cases ( 2. 6% ), and there was no duodenal papilla stenosis; In EST group, bile duct recurrent stones were complicated in 18 cases ( 15.8% ), duodenal papilla stenosis in 9 cases (7.9%), and cholangitis in 14 cases( 12. 3% ). There were significant differences among these three groups for these three complications( x2 = 6. 482, 9. 160, and 12. 020 respectively,P < 0. 05 ), and the rate of complications in EST group was higher than that in other two groups. Conclusion For common bile duct stones, EPBD is the first choice followed by LCBDE while EST is only indicated for very few cases.