摘要:
Objective To investigate the clinical effect of laparoscopic cholecystectomy ( LC) combined with en-doscopic sphincterotomy ( EST) in treatment of cholelithiasis complicated by choledochal stricture end or thin choledocho-lith. Methods A total of 87 patients with cholelithiasis complicated by choledochal stricture end or thin choledocholith admitted during July 2008 and July 2013 were divided into observation group ( n=45 ) and control group ( n=42 ) ac-cording to the therapy methods. The control group was given conventional open surgery, while the observation group was given LC combined with EST. The removed stones condition, intraoperative bleeding volume, operation time, hospital stay, postoperative complications and calculus recurrence in the two groups were observed and compared. The level chan-ges of direct bilirubin, white blood cell count, alanine transarninase (ALT) and C-reactive protein on postoperative 3rd and 7th d in the two groups were also observed and compared. Results All the stones were cleared, and no stone was left in the two groups. Compared with those in the control group, less intraoperative bleeding volume, shorter operation time and hospital stay were found in observation group, and the differences were statistically significant (P 0. 05 ). Conclusion The laparoscopic cholecystectomy combined with endoscopic sphincterotomy in treatment of cholelithiasis complicated by choledochal stricture end or thin choledocholith has a higher stone clearance rate, shorter operation time and hospital stay and less intraoperative bleeding volume. It has quicker digestion of postoperative obstructive jaundice and recovery of liver function with less inflammatory response.%目的:研究胆石症合并胆总管末端狭窄或细径胆总管结石患者应用腹腔镜胆囊切除术( laparoscopic cholecystectomy, LC)联合十二指肠镜下乳头切开术( endoscopic sphincterotomy, EST)治疗的临床效果。方法选择武警河南总队医院2008年7月—2013年7月收治的87例胆石症合并胆总管末端狭窄或细径胆总管结石,依据治疗方式分为研究组(n=45)与对照组(n=42),对照组行常规开腹手术治疗,研究组行LC联合EST治疗。对比观察两组结石取出情况,术中出血量,手术时间,住院时间,术后3、7d血中直接胆红素、白细胞计数、丙氨酸转氨酶、C-反应蛋白的变化,术后并发症发生及结石复发情况。结果两组结石均取净,无残留结石。与对照组比较,研究组术中出血量少,手术时间、住院时间短,差异均有统计学意义(P0.05)。结论胆石症合并胆总管末端狭窄或细径胆总管结石患者应用LC联合EST治疗,不仅结石取净率高,手术时间、住院时间短,术中出血量、并发症少,而且术后梗阻性黄疸消解迅速、肝功能恢复快、炎症反应少,临床应结合患者具体情况制定个体化治疗方案予以推广。