腹腔镜联合胰十二指肠镜治疗胆囊结石伴胆总管结石效果观察

张雷，林小波

（西安医学院第一附属医院普外科，陕西 西安，710077）

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摘要：

目的 探讨腹腔镜联合胰十二指肠镜治疗胆囊结石合并胆总管结石的效果。方法 选择我院收治的100例胆囊结石伴胆总 管结石患者，将其按照不同治疗方法分为治疗组和对照组，各50例。治疗组患者先于内镜下逆行胰胆管造影（ERCP）及内镜乳头括约肌切开取石术（EST）处理胆总管结石，后行腹腔镜胆囊切除术（LC）处理胆囊结石。对照组患者行传统胆囊切除胆总管切开取石T 管引流术。对两组患者的手术时间、术中出血量、术后疼痛评分、术后排气时间及住院时间、并发症发生率等进行对比分析。结果 两组患者的手术时间、术中出血量、术后疼痛评分、术后排气时间及住院时间比较，差异具有统计学意义（P< 0.05）；两组并发症发生率比较，差异无统计学意义（P>0.05）。结论 腹腔镜联合胰十二指肠镜治疗胆囊结石合并胆总管结石是一种安全有效的治疗方法，较传统胆囊切除胆总管切开取石T 管引流术，具有手术时间短、术中出血少、术后疼痛轻、术后排气时间及住院时间短的优点，且并发症发生率并没有提高，同时避免了放置T 管，提高了患者的生活质量，值得广泛推广。

关键词：腹腔镜；胰十二指肠镜；胆囊结石；胆总管结石

中图分类号：R657.4文献标志码：A文章编号：2096-1413(2017)18-0053-03

Effect of laparoscopy combined with pancreatic and duodenal endoscopy in the treatment of gallstone with common bile duct stones
ZHANG Lei, LIN Xiao-bo
(Department of General Surgery, the First Affiliated Hospital of Xi``an Medical University, Xi``an 710077, China)

ABSTRACT: Objective To explore the therapeutic effect of laparoscopy combined with pancreatic and duodenal endoscopy in the treatment of gallstone with common bile duct stones. Methods One hundred cases of gallstone with common bile duct stones admitted in our hospital were selected and randomly assigned to treatment group and control group, with 50 cases in each group. The patients in the treatment group were treated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) to treat choledocholithiasis, then accepted laparoscopic cholecystectomy (LC) to treat gallstone. The control group were treated with choledocholithotomy and T tube drainage. The operation time, blood loss, postoperative pain scores, postoperative exhaust time and hospital stay and incidence rate of complications were compared and analyzed between the two groups. Results The differences of operation time, blood loss, postoperative pain scores, postoperative exhaust time and hospital stay between the two groups were significant (P<0.05), and there was no significant difference in the incidence rate of complications (P>0.05). Conclusion For patients with gall stone with common bile duct stones, laparoscopy combined with pancreatic and duodenal endoscopy is safe and effective. Compared with the choledocholithotomy and T tube drainage, it has shorter operation time, postoperative exhaust time and hospital stay, less bleeding, lighter postoperative pain, but the incidence rate of complications won``t increase. At the same time, it can avoide the troubles of placing T tube, and improve patients`` quality of life, which is worthy of extensive promotion.
KEYWORDS: laparoscope; pancreatic and duodenal endoscopy; gallstone; common bile duct stones

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