胆总管结石内镜和手术治疗效果的对照分析.pdfVIP

一 228一 现代消化及介入诊疗 2007年 第1 2卷 第4期 Modem DigestionIntervention 2007，Vo1．1 2，No．4 · 论 著· 胆总管结石内镜和手术治疗效果的对照分 析 苏秉忠 陈 平 宋建忠 于金华 马丽丽 【摘要】目的对照分析内镜和手术治疗胆总管结石的效果。方法 胆总管结石471例，其中内镜治疗 365例，常规外科手术106例。采用EST、Pre—cut、EST后ENBD等方法，比较内镜治疗和常规手术治疗的 效果，以及在适应症、并发症发生率和医疗费用等方面的不同。结果 365例胆总管结石内镜取石成功359 例，成功率98．36％。EST后总的早期并发症为10．86％(39／359)，原因主要为胆管炎，占61．54％(24／39)，而 EST后行ENBD者早期并发症仅为2．96％(8／270)，EST无后期并发症。内镜取石平均住院时间仅为3 d。 开腹手术创伤大，可产生胆管狭窄、胆管炎、肝功损害等并发症，住院时间7～18d，平均12d，EST的医疗 费用显著低于开腹手术。结论 EST对胆总管结石在住院时间、费用和并发症发生率方面都明显优于常规 手术。 【关键词】胆总管结石；内镜治疗；手术治疗；效果 Effect of endoscopic treatment for common bile duct stone comparing t0 surgery SU Bing-zhong．CHEN Ping．SONG Jian—zhong．el a1．Department of Gastroenterology．Affiliated Hospita1．Inner Mongolia Medical College，Hohhot 010050，China 【Abstract】0bjective To evaluate the value of EST and surgery in the treatment of common bile duct stone．Method Four—hundred and seventy—one patients with comm on bile duct stone were studied， among which 365 cases were treated by endoscopy and 106 cases were treated by routine surgery．The outcome of operation，the skill of EST，tl1e application of Pre—cut，and the need of ENBD after EST were evaluated．Result Three——hundred and fifty-nine patients with common bile duct stone were successfully treated by the stone ex—— traction with endoscopy， with success rate being 98．36％． Th e total early complication rate after EST was l0．86％(39／359)which was mainly cholangitis，accounting for 61．54％(24／39)．The early complication rate after ENBD was only 2．96％(8／270)．There was no late complication after EST．The average hospitalization time of patients in EST group was 3 days．In surgery group there were more organ injuries，including biliary tract stricture，cholangitis，and liver function damage．The average hospitalization time in operation group was 12 days．Th e medical expenditure in EST group wa