开腹应用胆道镜与内镜下括约肌切开术治疗胆囊切除术后胆总管结石的临床疗效.pdf

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1、·154·皖南医学院学报(JofWannanMedicalCollege)2014；33(2·临床医学·文章编号：1002—0217(2014)02—0154—03开腹应用胆道镜与内镜下括约肌切开术治疗胆囊切除术后胆总管结石的临床疗效胡光龙，杭健，王晨(芜湖市第二人民医院急诊外科，安徽芜湖241001)【摘要】目的：比较开腹应用胆道镜与经内镜逆行胰胆管造影(ERCP)行十二指肠乳头切开取石术(EST)治疗胆囊切除术后胆总管结石的疗效。方法：选择我院2010年1月～2013年1月行开腹应用胆道镜治疗术后胆总管结石患者46例(胆道镜组)；选择同期行ERCP／EST治疗术

2、后胆总管结石患者52例(EST组)，对两组手术适应证、手术时间、住院时间、操作成功率、残余结石率、并发症发生率进行比较分析。结果：两组手术时间、操作成功率、并发症发生率比较差异无统计学意义(P>0．05)；胆道镜组和EST组住院时间分别为(19．44-4．5)和(11．44-5．2)d，两组比较差异有统计学意义(P<0．05)；两组残余结石率分别为6．5％(3／46)和21．2％(11／52)，两组比较差异有统计学意义(P<0．05)。结论：开腹应用胆道镜与行ERCP／EST均是治疗术后胆总管结石的有效方法，治疗各有优劣，应根据胆囊切除术后胆总管结石的具体情况，选择

3、适宜治疗方案。【关键词】胆总管结石；胆道镜；内镜逆行胰胆管造影；十二指肠乳头切开取石术【中图号】R657．4【文献标识码】A【DOI】10．3969／j．issn．1002-0217．2014．02．020Clinicaloutcomesofaparotomycombinedwithch0led0chOscOpeandERCP／ESTforcommon．bileductstonesaftercholecystectomyHUGuanglong，HANGJian，WANGChertDepartmentofEmergencysurgery，WuhuNo．2PeopleS

4、Hospital，Wuhu241001，China【Abstract】Objective：Toevaluatetheindicationandclinicalefficacieslaparotomycombinedwithcholedochoscopeandendoscopicretrogradecholangio—pancreatography／endoscopicsphincterotomy(ERCP／EST)intreatmentofcommonbileductstonesaftercholecystectomy．Methods：Forty—sixepatie

5、ntswithcommonbileductstonesaftercholecystectomyundergonelaparotomycombinedwithch0ledochos。叩ebetweenJanuary2010andJanuary2013wereincludedasch01edochosc0pegroup，and52patientswithcommonbileductstonesaftercholecystectomyreceivedERCP／ESTinsameperiodwereselectedasESTgroup．Thetwogroupswerecom

6、paredconcerningtheindications，operationtime，hospitalstay，successfulprocedure，incidenceofresidualstoneandpostoperativecomplication．Results：Thetwogroupswerenotdifferentregardingtheoperationtime，successfulprocedureandincidenceofpostoperativecomplication(P>0．05)．Thehospitalstaywas(19．4±4．5

7、)daysforcholedochoscopegroupand(11．4±5．2)daysinESTgroup，andtheincidenceofresidualstonewas6．5％(3／46)fortheformerand21．2％(11／52)forthelatter(P<0．05)．Thetwogroupsweresignificantlydifferent(P<0．05)．Conclusion：BothlaparotomycombinedwithcholedochoscopeandERCP／ESTareeffectiveinthetreatmento