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1、肝外胆管结石的微创治疗作者:纪程宏，姜，杰，庄建民,郭久冰作者单位:福建省厦门市第二医院海沧医院，福建厦门，361026【摘要】冃的：探讨腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)+胆总管探查术(commonbileductexploration,CBDE)与内镣卜Oddi括约肌切开术(endoscopicsphincterotomy,EST)联合LC治疗胆囊疾病合并胆总管结石的临床效果及术式选择。方法：2001年4月〜2007年12月我院采用微创外科技术治疗胆囊结石合并胆总管结石患者66例，其中
2、LC+CBDE组48例，EST组18例，比较两组患者的手术时间、术中出血量、术后肠功能恢复时间、术后住院天数、住院总费用、并发症发生率、结石消除率等指标。结果：LC+CBDE组与EST组手术吋间、术中出血量、术后肠功能恢复时间、结石消除率等指标差异无显著性(P>0.05),LC+CBDE组住院总天数、住院总费用、并发症发生率明显少于EST组(P<0.01)o结论：两种术式各有其适应证和优缺点，胆总管直径<1.0cm时以行EST取石术为宜，2〜5d后再行LC。既往有胆道手术史者亦EST取石为宜。胆总管直径>1.0cm,尤其是并存二级胆管
3、结石者(无胆•管狭窄)则宜行LC+CBDEo【关键词】胆总管结石;腹腔镜术;胆总管探查术;括约肌切开术;内窥镜检查MinimallyinvasiveprocedureintreatinggallbladdercalculiwithcholedocholithiasisJIChenghong,JIANGJie,ZHUANGJianmin,etal.Dept.ofGeneralSurgery,theSecondHospitalofXiamenCity,Xiamen361026,China[Abstract]Objective:Toinve
4、stigatetheclinicaleffectoflaparoscopiccholecystectomy(LC)+commonbileductexploration(CBDE)andendoscopicsphincterotomy(EST)combinedwithLContreatingthegallbladderdiseasewithcholedocholithiasis.Methods:Thetwominimallyinvasiveprocedureswerecarriedout,whichhadsixtysixcasesofc
5、holecystolithiasisandcommonductstonesfromAp匚2001toDec.2007.Thepatientsweredividedintotwogroups,withLC+CBDEgroup48casesandESTgroup18casesrespectively.Theclinicaldatawerecompared,suchasoperativetime,bloodloss,gastrointestinalfunctionrecoverytime,postoperativehospitalizati
6、on,cost,incidenceofcomplicationandclearancerateofstone.Results:Therewasnosignificantdifferencebetweenthetwogroupsaboutoperativetime,bloodloss,gastrointestinalfunctionrecoverytimeandclearancerateofstone.(P>0.05).Butthereweresignificantdifferencesinthepostoperativehospita
7、lization,cost,incidenceofcomplication(P<0.01).Conclusions:Therearerespectiveindication,advantageanddisadvantagebetweenthetwogroups.Ifthecommonbileductislessthan1.0cmindiameter,ESTshouldbeperfomedatfirst,followedwithLC25dayslatecOtherwise,thebetterwayisLC+CBDE,especially
8、forsecondaryintrahepaticbileductcalculi(notcomplicatedwithstrictureofbileduct).【Keywords】Commonbileductcalculi
