胆囊结石切除胆囊及保胆取石循证医学思索.docVIP

胆囊结石切除胆囊及保胆取石循证医学思索摘 要 胆囊结石是普外科的常见病，目前胆囊切除术是治疗胆囊结石的金标准。近20年来国内一些学者对传统的切胆理论提出了挑战，认为对胆囊功能良好的胆囊结石患者采用保胆取石有望成为胆囊切除术的替代疗法之一。但是保胆取石目前尚无公认的手术指证，而且在胆囊结石成因研究尚无突破性进展的前提下，其术后结石高复发率的争论是焦点之一，而且对其疗效尚缺乏高质量的大样本、多中心随机对照研究。本文从循证医学的观点分析保胆取石治疗胆囊结石的潜在应用价值。 关键词 胆囊结石 胆囊切除术 保胆取石 循证医学 中图分类号：R575.6+2 文献标识码：C 文章编号：1006-1533（2012）12-0003-03 Operation of gallstones: Cholecystectomy or gallbladder-preserving cholecystolithotomy from the point of view of EBM ? WU Gang, CHEN Jin-hong, CAI Duan (Huashan Hospital, Fudan University, Shanghai, 200040) ABSTRACT Gallstone disease is a very common disorder of the general surgery, Cholecystectomy is considered the gold standard treatment of choice for symptomatic gallstones. During the past two decades, gallbladder-preserving cholecystolithotomy had been introduced as alternatives to cholecystectomy for gallstones by some Chinese authors. They suggested that gallbladder-preserving cholecystolithotomy might become one of the alternative therapies for gallstones patients with normal gallbladder function. But there are no recognized surgical indications on gallbladder-preserving cholecystolithotomy now. Without the breakthrough in the premise of the genesis of gallstones, postoperative high rate of recurrence of stone is the focus of debate on gallbladder-preserving cholecystolithotomy. There are not large samples of high-quality, multi-center randomized controlled studies at present. We analyze the potential value of gallbladder-preserving cholecystolithotomy from the point of view of the evidence-based medicine. KEY WORDS gallstones; cholecystectomy; gallbladder-preserving cholecystolithotomy; evidence based medicine 胆囊结石是国内外的常见病，上海交通大学医学院附属瑞金医院对6 844名上海市区20～79岁常住居民的调查发现，已接受胆囊切除的占2.49%，尚未手术者胆囊结石检出率为9.06%，两者合计为11.55%[1]。1999年法国学者报告的胆囊结石超声检出率为13.90%[2]。胆囊结石患者如此之多，既是医学问题，更是一个社会经济问题。自1882年Langenbuch通过开腹胆囊切除术治疗胆囊结石100多年来，因其疗效明确而成为胆囊结石的标准治疗。同时人们对胆囊结石的治疗进行了不懈的研究和探索，但是口服药物溶石治疗、灌注溶石治疗、体外震波碎石治疗、中西医结合治疗等均因疗效有限及结石的高复发率而最终弃用[1,3]。随着腹腔镜技术的发展，目前腹腔镜胆囊切除术（l