胆囊-胆总管结石不同治疗方案的临床分析

Ping Chen, Bingzhong Su, Chunli Cong, Hongxia Wang, Tong-ling Zhang, Jianjun Ren, Qi Wang, Xudong Liu
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摘要

目的评价不同治疗方案治疗胆囊胆总管结石的疗效,寻求理想的治疗方案。方法选取2006年1月~ 2016年1月内蒙古医科大学附属医院CCL患者3 107例。其中,开放胆囊切除术(OC) +开放胆总管探查(OCBDE)组1 283例,腹腔镜胆囊切除术(LC) +腹腔镜胆总管探查(LCBDE)组964例,内镜逆行胰胆管造影(ERCP)+ LC组860例。分析三组患者的临床资料。统计学分析采用单因素方差分析和卡方检验。结果2006 - 2010年,OC+ OCBDE、LC+ LCBDE和ERCP+ LC治疗的患者比例分别为56.05%(829/1 479)、25.15%(372/1 479)和18.80%(278/1 479);2011 - 2016年,接受上述三种治疗的患者比例分别为27.89%(454/1 628)、36.36%(592/1 628)和35.75%(582/1 628)。不同时间相同治疗比例差异有统计学意义(χ2=4.775、4.168、0.669,P均为0.05)。OC+ OCBDE组、LC+ LCBDE组和ERCP+ LC组住院时间分别为(6.7±1.3)d、(5.6±1.2)d和(10.9±1.6)d,差异有统计学意义(F=90.010, P<0.01)。OC+ OCBDE组、LC+ LCBDE组、ERCP+ LC组住院费用分别为(13 720±1 910)元、(18 150±1 490)元、(25 830±2 430)元,差异有统计学意义(F=302.991, P<0.01)。结论内镜下微创治疗是CCL患者的首选,开放手术可作为内镜下治疗的一种补救方法。关键词:胆囊胆总管结石;内镜微创治疗;开放手术
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Clinical analysis of different treatment options for cholecysto-choledocholithiasis
Objective To evaluate the efficacy of different treatment options for cholecysto-choledocholithiasis (CCL), and try to find the ideal treatment. Methods From January 2006 to January 2016, a total of 3 107 patients with CCL from the Affiliated Hospital of Inner Mongolia Medical University were enrolled. Among them, 1 283 patients were in open cholecystectomy (OC) and open common bile duct exploration (OCBDE) group, 964 patients were in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) group, and 860 patients were in endoscopic retrograde cholangiopancreatography (ERCP)+ LC group. The clinical data of the three groups were analysed. One-way analysis of variance and chi-square test were performed for statistical analysis. Results From 2006 to 2010, the percentage of patients treated with OC+ OCBDE, LC+ LCBDE, and ERCP+ LC were 56.05%(829/1 479), 25.15%(372/1 479) and 18.80%(278/1 479), respectively; from 2011 to 2016, the percentage of patients received the above three treatments were 27.89%(454/1 628), 36.36%(592/1 628) and 35.75%(582/1 628), respectively. The difference in the proportion of the same treatment at different times was statistically significant (χ2=4.775, 4.168 and 0.669, all P 0.05). The hospital stay of the OC+ OCBDE group, the LC+ LCBDE group and the ERCP+ LC group were (6.7±1.3) days, (5.6±1.2) days and (10.9±1.6) days, respectively, and the differences were statistically significant (F=90.010, P<0.01). The hospitalization expenses of OC+ OCBDE group, LC+ LCBDE group and ERCP+ LC group were (13 720±1 910) yuan, (18 150±1 490) yuan and (25 830±2 430) yuan, respectively, and the differences were statistically significant (F=302.991, P<0.01). Conclusion The first choice of patients with CCL is endoscopic minimally invasive treatment and open surgery can be used as a remedial method for endoscopic treatment. Key words: Cholecysto-choledocholithiasis; Endoscopic minimally invasive treatment; Open surgery
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