CAJ | 학술논문

目的评价腹腔镜胆囊切除术(laparoendoscopy,LC)联合逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)+十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)一期治疗胆囊结石及胆总管结石的安全性.方法 63例患者分成2组,试验组31例,对照组32例,试验组在全麻下先行ERCP+ EST,取出胆总管结石,之后直接行腹腔镜下胆囊切除术;对照组先在全麻下行ERCP及EST,取出胆总管结石,3～5d后再于全麻下行腹腔镜胆囊切除术.结果结石清除率分别为96.9％和96.7％,术后肺部感染分别为7.1％(n=2)和16.1％(n=5);平均住院时间(7.5±1.7)d和(12.6±2.5)d,试验组术后肺部感染和平均住院时间对照组明显减少(分别x2=6.203,t =2.74,均P＜0.05).结论 LC术中联合EST一期治疗胆囊结石合并胆总管结石,与先行EST,3～5d后再行腹腔镜胆囊切除术相比,一样安全、有效,并且肺部感染明显减少,平均住院时间显著缩短.
목적 평개복강경담낭절제술(laparoendoscopy,LC)연합역행이담관조영(endoscopic retrograde cholangiopancreatography,ERCP)+십이지장유두괄약기절개술(endoscopic sphincterotomy,EST)일기치료담낭결석급담총관결석적안전성.방법 63례환자분성2조,시험조31례,대조조32례,시험조재전마하선행ERCP+ EST,취출담총관결석,지후직접행복강경하담낭절제술;대조조선재전마하행ERCP급EST,취출담총관결석,3～5d후재우전마하행복강경담낭절제술.결과 결석청제솔분별위96.9％화96.7％,술후폐부감염분별위7.1％(n=2)화16.1％(n=5);평균주원시간(7.5±1.7)d화(12.6±2.5)d,시험조술후폐부감염화평균주원시간대조조명현감소(분별x2=6.203,t =2.74,균P＜0.05).결론 LC술중연합EST일기치료담낭결석합병담총관결석,여선행EST,3～5d후재행복강경담낭절제술상비,일양안전、유효,병차폐부감염명현감소,평균주원시간현저축단.
Objective To evaluate the safety and efficacy of one-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for the treatment of patients who have concurrent gallstones and CBD stones.Methods We conducted a prospective study from Mar 2008 to Nov 2011 in our department.A total of 63 consecutive patients of concurrent gallstones and CBD stones were included and divided into two groups:31 patients in test group first underwent ERCP and EST to remove CBD stones,and then during the same general anesthesia underwent laparoscopic cholecystectomy (LC) ; while 32 patients in control group first underwent ERCP and ES,and then LC 3-5 days later.Results The stone clearance rate in test group and control group were 96.9％ and 96.7％ (P ＞ 0.05),respectively.The postoperative lung infection rate in the test group and the control group were 7.1％ and 16.1％ (P ＜0.05),respectively.The length of hospital stay (LOS) of the two groups was (7.5 ± 1.7) days and (12.6 ±2.5) days,respectively (P ＜ 0.05).The total expense of hospitalization was (￥) (2 356 ± 126) and (￥) (37 056 ± 152),respectively (P ＜ 0.05).Conclusions One-stage laparoendoscopic management of patients with concurrent gallstones and CBD stones is safe,effective and more economic approach than two-stage treatment for patients suffering from concurrent gall stone and choledocholithiasis.