腹腔镜经胆囊管胆道镜取石治疗胆总管结石的临床研究

A comparative study on clinical curative effect of transcystic choledochoscopic minimally invasive surgeryand LCBDE on common bile duct stones in laparoscopy

目的探讨腹腔镜经胆囊管胆道镜取石术治疗胆总管结石患者临床疗效。方法选取2016年1月至2020年1月期间我院收治的胆总管结石患者112例,所有患者首选尝试经胆囊管置入胆道镜探查胆总管,其中43例经胆囊管成功置入胆道镜取出胆总管结石设为试验组,另外69例采用腹腔镜胆总管探查术(Laparascopic common bile duct exploration, LCBD)设为对照组,比较两组患者术中、术后情况,住院时间,血清应激反应指标,炎症因子水平,术后并发症发生率。结果试验组患者的手术时间、术中出血量、住院时间以及引流管携带时间均低于对照组(P<0.05);两组患者术后白细胞计数(WBC)、中性粒细胞计数(NEUT)和C-反应蛋白(CRP)水平并没有差异(P>0.05);试验组和对照组患者术后出现切口感染、胆漏、胆道出血、胰腺炎等术后并发症发生率分别为6.98%和10.14%,差异无统计学意义(P>0.05)。结论与LCBDE术相比,腹腔镜经胆囊管胆道镜探查取石可显著降低胆总管结石患者手术时间、术中出血量、住院时间以及引流管携带时间,对于此类患者,应首选尝试经胆囊管置入胆道镜探查胆总管。

Objective To investigate the clinical efficacy of laparoscopic cholecystectomy with choledochoscope in the treatment of choledocholithiasis. Methods 112 cases of choledocholithiasis admitted to our hospital from January 2016 to January 2020 were selected, among them, 43 patients were successfully placed choledochoscope through the cystic duct to set the common bile duct stone as the experimental group, and the other 69 patients were treated with LCBDE as the control group. The postoperative, postoperative, hospitalization time, serum stress response index, inflammatory factor level and postoperative complication rate of the two groups were compared between the two groups. Results The operative time, intraoperative blood loss, hospitalization time and drainage tube carrying time in the experimental group were lower than those in the control group(P<0.05).There was no difference in white blood cell count(WBC), neutrophil count(NEUT) and C-reactive protein(CRP) level between the two groups(P>0.05).The incidence of postoperative complications such as incision infection, bile leakage, biliary tract hemorrhage, pancreatitis and so on in the experimental group and the control group were 6.98% and 10.14% respectively, and the difference was not statistically significant(P>0.05).Conclusion Compared with LCBDE, laparoscopic cholecystocholithotomy by choledochoscope can significantly reduce operation time, blood loss, hospitalization timeand drainage tube carrying time. If intraoperative choledochoscope can be placed through cystic duct, bile duct should be selected through cystic duct.