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1、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】目的：探讨腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)+胆总管探杳术(commonbileductexploration,CBDE)与内镜下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
2、、术后肠功能恢复时间、术示住院天数、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片无显箸性(P0.05),LC+CBDE组住院总天数、住院总费用、并发症发生率明显少TEST组(P0.01)。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収石术为宜，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Minimallyin
3、vasiveprocedureintreatinggallbladdercalculiwithcholeclocholithiasisJIChenghongJIANGJie,ZHUANGJianmin,etal.Dept.ofGeneralSurgery,theSecondHospitalofXiamenCity,Xiamen361026,China[Abstract]Objective:Toinvestigatetheclinicaleffectoflaparoscopiccholecystectomy(LC)+commonbileductexploration(CBDE)anden
4、doscopicsphincterotomy(EST)combinedwithLContreatingthegallbladderdiseasewithcholedocholithiasis.Methods:Thetwominimallyinvasiveprocedureswerecarriedout,whichhadsixtysixcasesofcholccystolithiasisandcommonductstonesfromApr.2001toDec.2007.Thepatientsweredividedintotwogroups,withLC+CBDEgroup48casesa
5、ndESTgroup18casesrcspcctivcly.Thcclinicaldatawerecompared,suchasoperativetime,bloodloss,gastrointestinalfunctionrecoverytime,postoperativehospitalization,cost.incidenceofcomplicationandclearancerateofstone.Results:Therewasnosignificantdifferencebetweenthetwogroupsaboutoperativetime,bloodloss,gas
6、trointestinalfunctionrecoverytimeandclearancerateofstone.(P0.05).Butthereweresignificantdifferencesinthepostoperativehospitalization,cost,incidenceofcomplication(P0.01).Conclusions:Thcrcarcrespectiveindication,advantageanddisadvantagebetweenthetwogroups.Ifthecommonbileductislessthan1.0cmindiamet
7、er,ESTshouldbeperfomedatfirst,followedwithLC25dayslate匚Otherwise.thebetterwayisLC+CBDE,especiallyforsecondaryintrahepaticbileductcalculi(notcomplicatedwithstrictureofbileduct).【Keywords】Commonbileductcalculi;Laparoscopy;Expl
