摘要
目的探讨腹腔镜、胆道镜及十二指肠镜三镜联合“一步法”治疗胆总管结石合并胆囊结石的安全性及其临床疗效。方法2012年2月至2014年2月53例确诊胆总管结石合并胆囊结石患者，29例采用腹腔镜、胆道镜及十二指肠镜三镜联合的“一步法”进行治疗（三镜联合组），24例采用先行内镜下胆管取石并放置鼻胆引流管，数天后再行腹腔镜下胆囊切除术（LC）切除胆囊的“二步法”进行治疗（对照组）。对2组术后并发症发生率、结石取净率、住院时间及住院费用进行比较分析。结果53例均成功手术。三镜联合组与对照组比较，术后并发症总发生率差异无统计学意义[3．4％（1／29）比12．5％（3／24），P=0．21]，结石取净率差异亦无统计学意义[96．6％（28／29）比100．0％（24／24），P=0．37]，但平均住院时间明显缩短[（6．7±1．3）d比（10．9±1．6）d，P〈0．01]，平均住院费用明显减少[（15724±1613）元比（19829±2433）元，P=0．03]。结论三镜联合“一步法”治疗胆总管结石合并胆囊结石安全、有效，可缩短患者住院时间，减轻患者经济负担，是一种具有较好临床应用价值的微创治疗方法。
Objective To evaluate a method named ＂one-step procedure＂, i. e. , combined duodenoscopy, laparoscopy and choledochoscopy for choledocholithiasis accompanied with cholecystolithiasis. Methods Fifty-three cases with gallbladder stones combined with common bile duct stones diagnosed from February 2012 to February 2014 were assigned to two groups, 29 cases in ＂one-step procedure＂ group, who underwent duodenoscopy, laparoscopy and choledochoscopy in one operation, and 24 cases in the control group, who firstly underwent endoscopic sphincterotomy to remove common bile duct stones, and then LC was performed after several days. The rate of complications related to the procedure, success rate of complete stone removal, length of hospital stay and hospitalization expenses were compared between the two groups. Results All 53 patients underwent the surgery and ERCP procedure successfully. There were no significant differences between the ＂one-step procedure＂ group and the eontrol group in complication rates [ 3.4% （1/29） VS 12. 5 % （3/24） ,P = 0. 21 ], complete stone removal rates [ 96. 6% （28/29）VS 100. 0% （24/24） ,P = 0. 37 ]. Differences were significant in length of hospital stay （6.7 ± 1.3d VS 10.9 ± 1.6d, P 〈0.01） and hospitalization expenses （ 15 724 ± 1 613 yuan VS 19 829 ± 2 433 yuan, P 〈 0. 05 ） between the ＂one-step procedure＂ group and the control group. Conclusion The ＂one-step procedure＂, the combined duodenoscopy, laparoscopy and choledoehoseopy, is safe, effective, and has smaller length of hospital stay and lower hospitalization expenses.
出处
《中华消化内镜杂志》
北大核心
2015年第5期277-280,共4页
Chinese Journal of Digestive Endoscopy
关键词
胆总管结石
胆囊结石
胰胆管造影术
内窥镜逆行
腹腔镜
Choledocholith
Choledocholithiasis
Cholangiopancreatography, endoscopic retrograde
Laparoscope
