刘胜　李载春

[摘要] 目的 探讨 EST联合LC治疗胆囊结石并发胆总管结石的临床效果。方法 对2012年6月～2013年8月期间来我院治疗的106例胆囊结石并发胆总管结石患者的临床资料进行回顾性分析，按照患者的治疗意愿分为观察组及对照组各53例，观察组采用EST+LC治疗，对照组采用OC+胆总管切开取石术+T管引流术治疗，比较两组的治疗结果。结果 观察组术中出血量明显少于对照组，术后肛门排气时间、肠鸣音恢复时间及住院时间明显短于对照组，镇痛药物使用率、结石残留率及并发症总发生率低于对照组，两组比较差异有统计学意义（P<0.05）。两组手术时间、手术成功率相近，两组比较差异无统计学意义（P>0.05）。 结论 胆囊结石并发胆总管结石患者采用EST联合LC方式治疗优点显著，对患者造成的创伤小，降低了术中出血量，术后伤口疼痛轻，并能在短期内恢复，可以在临床推广应用。

[关键词] 胆囊结石；胆总管结石；内镜十二指肠切开术；联合腹腔镜胆囊切除术

[中图分类号] R657.4 [文献标识码] B [文章编号] 1673-9701（2014）11-0140-03

[Abstract] Objective To investigate the clinical results of gallstones EST combined LC concurrent choledocholithiasis. Methods One hundred and six cases of gallbladder stones with common bile duct stones with clinical data were collected from June 2012 to August 2013 in our hospital were retrospectively analyzed， in accordance with the wishes of the patient they were divided into the observation group and the control group， each group had 53 cases， EST+LC in observation group therapy， the control group used OC+choledocholithotomy surgery+T tube drainage treatment， treatment outcomes were compared. Results The blood loss of observation group was significantly less than the control group， postoperative flatus，bowel sounds recovery time and hospital stay was significantly shorter in overall incidence in the control group， analgesic usage， residual stone rate and complication rate in the observation group was less than the control group， the difference was significant（P<0.05）. Two operative time，surgical success rates were similar，the difference was not have significant（P>0.05）. Conclusion Gallstone patients with concurrent choledocholithiasis EST combined LC way of treating have significant advantages， less trauma to the patient， reducing blood loss， postoperative wound pain， able to recover in the short term， etc.， can be used in clinical practice.

[Key words] Gallstones； Common bile duct stones； Endoscopic duodenal incision； Laparoscopic cholecystectomy

胆囊结石并发胆总管结石是普外科较为常见的一种疾病，结石阻塞时的程度及是否存在胆道感染为疾病临床表现及病情的决定因素。由于胆囊结石并发胆总管结石有发病急及病情重的特点，为一种常见的急腹症。临床多采用手术治疗，将胆总管切开取石，并且放置T管引流[1]。但是有报道表明，采用普通手术治疗胆囊结石并发胆总管结石患者需要承担较高的手术风险，术后愈合速度慢，容易发生多种并发症[2]。近年来，随着医疗技术的提高，腹腔镜技术在临床手术中被逐渐引入，这种方法不仅安全有效，而且患者承受的痛苦也小于传统手术方法[3]。……