双镜联合治疗胆囊结石并发胆总管结石的疗效观察

The efficacy observation on the treatment of gallbladder stones combined with common bile duct stones by dual endoscope

目的探讨内镜十二指肠切开术(EST)联合腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石的临床应用价值。方法按入院的先后顺序,将120例胆囊结石合并胆总管结石患者分为对照组与观察组,每组60例。观察组行(EST+LC)治疗,对照组行开腹胆囊切除术(OC)+胆总管切开取石术+T管引流术治疗。记录并比较两组患者手术时间、术中出血量、术后恢复情况及住院时间等临床指标。结果观察组与对照组的平均手术时间分别为(91.3±15.7)min和(89.7±16.3)min,组间差异无统计学意义(P>0.05);观察组的平均术中出血量(29.5±15.4)ml低于对照组(81.7±16.5)ml,组间差异有统计学意义(P<0.05);观察组的术后切口感染发生率(0%)、术后镇痛药物使用率(8.9%)、肛门排气时间(21.5±12.3)h及肠鸣音恢复时间(12.7±2.4)h均低于对照组[分别为:10.7%、51.8%、(70.5±7.8)h、(25.3±3.1)h];观察组的平均住院时间(8.1±1.5)d短于对照组(15.3±1.4)d,组间差异有统计学意义(P<0.05)。结论 EST联合LC治疗胆囊结石合并胆总管结石具有创伤小、出血少、术后伤口疼痛轻、恢复快等优点,优于开腹手术,具有较高的优越性和临床使用价值。

Objective To explore the clinical value of endoscopic duodenal incision（EST） combined with laparoscopic cholecystectomy（LC） in the treatment of gallbladder stones combined with common bile duct stones.Methods According to the order for admission,120 patients of gallbladder stones combined with common bile duct stones patients were divided into a control group and the observation group（n=60）.The observation group was given（EST＋ LC） treatment,the control group underwent open cholecystectomy（OC） ＋ the common bile duct lithotomy ＋ T tube drainage treatment.Recorded and compared between the two groups of patients with clinical indicators including operative time,blood loss,postoperative recovery and hospitalization time.Results Average operative time of the observation group and the control group were（91.3±15.7） min and（89.7±16.3） min,respectively,the difference between the groups was not statistically significant（P〈0.05）;average blood loss of observation group was（29.5±15.4） ml,which was lower than those in the control group（81.7 ml±16.5 ml）,the difference between the groups was statistically significant（P〈0.05）;in observation group,postoperative wound infection incidence（0%）,postoperative analgesic usage（8.9%）,anal exhaust time（21.5 h±12.3 h） and bowel sounds recovery time（12.7 h±2.4 h） were lower than the control group,respectively [10.7%,51.8%,（70.5±7.8） h,（25.3±3.1） h];in observation group,the average length of stay was（8.1d±1.5d） which was shorter than the control group（15.3d±1.4d）,the difference between the groups was statistically significant（P〈0.05）.Conclusion EST combined with LC trauma with less bleeding,postoperative wound pain and quick recovery was significantly better than open surgery in the treatment of gallbladder stones combined with common bile duct stones,it has a higher superiority and clinical value.