CAJ | 학술논문

目的：探讨和比较腹腔镜胆囊切除术(LC)术前行经内镜逆行性胰胆管造影术(ERCP)和内镜下括<肌切开术(EST)与LC术后行ERCP和EST治疗胆囊结石合并胆总管结石的效果。方法选取2009年9月~2012年12月在山西医科大学第一附属医院及太钢总医院入院的胆囊结石合并胆总管结石行LC及ERCP+EST的患者69例，其中LC术前行ERCP+EST 39例，LC术后行ERCP+EST 30例，比较两组的住院时间、并发症发生率、相关指标变化情况。结果术前组的住院时间短于术后组，差异有统计学意义(P<0.05)。术前组的发热、急性胰腺炎发生率均低于术后组，差异有统计学意义(P<0.05)；两组的出血、穿孔发生率比较差异无统计学意义(P>0.05)。术前组的白细胞升高、高淀粉酶血症发生率均低于术后组，差异有统计学意义(P<0.05)；两组的总胆红素值下降、ALT值下降发生率比较差异无统计学意义(P>0.05)。结论 LC术前行ERCP+EST具有并发症少、住院时间短等优点，对治疗胆囊结石合并胆总管结石具有广阔的应用前景，值得临床推广应用。
목적：탐토화비교복강경담낭절제술(LC)술전행경내경역행성이담관조영술(ERCP)화내경하괄<기절개술(EST)여LC술후행ERCP화EST치료담낭결석합병담총관결석적효과。방법선취2009년9월~2012년12월재산서의과대학제일부속의원급태강총의원입원적담낭결석합병담총관결석행LC급ERCP+EST적환자69례，기중LC술전행ERCP+EST 39례，LC술후행ERCP+EST 30례，비교량조적주원시간、병발증발생솔、상관지표변화정황。결과술전조적주원시간단우술후조，차이유통계학의의(P<0.05)。술전조적발열、급성이선염발생솔균저우술후조，차이유통계학의의(P<0.05)；량조적출혈、천공발생솔비교차이무통계학의의(P>0.05)。술전조적백세포승고、고정분매혈증발생솔균저우술후조，차이유통계학의의(P<0.05)；량조적총담홍소치하강、ALT치하강발생솔비교차이무통계학의의(P>0.05)。결론 LC술전행ERCP+EST구유병발증소、주원시간단등우점，대치료담낭결석합병담총관결석구유엄활적응용전경，치득림상추엄응용。
Objective To explore and compare the efficacy of endoscopic retrograde cholangio-pancreatography(ERCP) plus endoscopic sphincterotomy(EST)before and after laparoscopic cholecystectomy(LC)in the treatment of cholelithiasis complicated with choledocholithiasis. Methods 69 cases of patients with cholelithiasis complicated with choledo-cholithiasis in the First Affiliated Hospital of Shanxi Medical University and the General Hospital of TISCO from September 2009 to December 2012 were selected and received LC and ERCP plus EST.39 patients received ERCP plus EST before LC and 30 patients received ERCP plus EST after LC.Hospitalization time,incidence rate of complica-tion and the relevant index change in two groups was compared respectively. Results Hospitalization time in preopera-tive group was shorter than that in postoperative group,with statistical difference (P<0.05).The incidence rate of fever and acute pancreatitis in preoperative group was lower than that in postoperative group respectively,with statistical dif-ference(P<0.05).The incidence rate of bleeding and perforation in two groups was compared respectively,with no statis-tical difference(P>0.05).The incidence rate of increase leukocytes and hyperamylasemia in preoperative group was lower than that in postoperative group respectively,with statistical difference(P<0.05).The incidence rate of total bilirubin val-ue falls and ALT value decline in two groups was compared respectively,with no statistical difference (P>0.05). Con-clusion ERCP plus EST carried out before LC has advantages of less complication and shorter hospitalization time,and has a wide prospect of application in the treatment of cholelithiasis complicated with choledocholithiasis,which is wor-thy of clinical promotion and application.