胆囊结石合并胆总管结石患者应用腹腔镜联合胆道镜经胆囊管钬激光碎石术治疗的临床观察

Patients with cholecystolithiasis combined with choledocholithiasis were treated with laparoscopy combined with choledochoscope transcholecystic holmium laser lithotripsy Clinical observation of treatment

目的:探究腹腔镜联合胆道镜经胆囊管钬激光碎石术对胆囊结石合并胆总管结石(CWCC)患者的临床治疗效果。方法:将2020年1月~2023年6月我院收治的70例CWCC患者作为研究对象。使用数字随机法分为激光碎石组和常规取石组,两组各35例。激光碎石组接受腹腔镜联合胆道镜经胆囊管钬激光碎石术治疗,常规取石组接受常规结石治疗方案。记录两组患者围手术期相关参数[手术时间、住院时间、肛门排气时间];分别于术前和术后72 h检测临床指标[总胆红素(TBIL),天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)];观察两组患者术后并发症(胆漏、结石残留、胰腺炎)发生情况。结果:激光碎石组患者手术时间、住院时间、肛门排气时间均短于常规取石组(P<0.05)。术后72 h激光碎石组患者AST、TBIL、ALP水平均低于常规取石组(P<0.05)。激光碎石组患者术后并发症发生率为5.71%,低于常规取石组的22.86%(P<0.05)。结论:腹腔镜联合胆道镜经胆囊管钬激光碎石术能够有效降低CWCC患者的手术时间和住院时间、改善患者预后、恢复肝功能水平,且术后并发症发生率较低。

Objective:To investigate the clinical effect of laparoscopic combined choledochoscopic holmium laser lithotripsy on patients with cholecystolithiasis combined with choledocholithiasis(CWCC).Methods:70 patients with CWCC admitted to our hospital from January 2020 to June 2023 were selected as the study objects.They were divided into laser lithotripsy group and conventional lithotripsy group with 35 cases in each group.The laser lithotripsy group received holmium laser lithotripsy via gallbladder duct by laparoscopy combined with choledochoscope,and the conventional lithotripsy group received conventional lithotripsy treatment.Perioperative parameters(operation time,hospital stay,anal exhaust time)were recorded in the two groups.The clinical indexes(total bilirubin(TBIL),aspartate aminotransferase(AST),alanine aminotransferase(ALT))were detected before and 72 h after surgery,respectively.Postoperative complications(biliary leakage,residual stone,pancreatitis)were observed in the two groups.Results:The operation time,hospital stay and anal exhaust time in laser lithotripsis group were shorter than those in conventional lithotripsis group(P<0.05).The levels of AST,TBIL and ALP in laser lithotripsis group were lower than those in conventional lithotripsis group 72 h after operation(P<0.05).The incidence of postoperative complications in the laser lithotripsis group was 5.71%,lower than that in the conventional lithotripsis group(22.86%)(P<0.05).Conclusion:Laparoscopic combined choledochoscopic transcholecystic holmium laser lithotripsy can effectively reduce the operation time and hospital stay of CWCC patients,improve the prognosis of patients,restore the level of liver function,and the incidence of postoperative complications is low.