腹腔镜联合胆道镜两种术式治疗胆囊结石合并胆总管结石的临床疗效比较

Comparison of two approaches of laparoscope combined with choledochoscope in treatment of cholecystolithiasis and choledocholithiasis

目的对比腹腔镜经胆囊管胆道探查术(laparoscopic trans·cystic bile duct exploration,LTCBDE)与腹腔镜胆总管探查一期缝合术(laparoscopic common bile duct exploration and primary suture,LBEPS)治疗胆囊结石继发胆总管结石的疗效,分析两种于术方式在临床上的应用价值。方法胆囊结石合并胆总管结石患者157例,依据手术方式不同,将其分为LTCBDE组(95例)和LBEPS组(62例),比较两组患者手术时间、住院时间、住院总费用及术后并发症(胆漏、胆道感染、切口感染)等临床指标。结果 LTCBDE组术后住院时间[(11.1±3.3)d vs(13.7±4.6)d]、住院总费用[(3.0±0.4)万元vs(3.2±0.3)万元]均低于LBEPS组,差异有统计学意义(P<0.05),两组患者手术时间[(113.6±21.0)min vs(110.4±18.5)min]、术后并发症(5例vs 8例)比较,差异无统计学意义(P>0.05)。结论 LTCBDE是一种安全、有效、可行的手术方式,可作为治疗胆囊结石继发胆总管结石的一种优先选择方案之一。

Objective Comparative study on clinical efficacy and outcomes between laparoscopic trans-cystic bile duct exploration（LTCBDE）and laparoscopic trans-cystic bile duct exploration（LBEPS） in the treatment of cholecystolithiasis and secondary choledocholithiasis. Methods A retrospective analy-sis of a total 157 cases with both cholecystolithiasis and choledocholithiasis. According to different surgical methods,they were divided into two groups：LTCBDE group（n = 95）and LBEPS group（n = 62）. Compara-tive analysis of patients operation duration,intra operative blood loss,hospital stay,total hospital cost and post operative complications（bile leakage,biliary tract infection,wound infection,etc. ）of the two groups. Results The group LTCBDE′s operative hospital stay[（11. 1 ± 3. 3）d vs（13. 7 ± 4. 6）d]＆amp; total hospi-tal cost[（30 ± 4）thousand vs（32 ± 3）thousand]were lower than group LBEPS,the difference was statis-tically significant（P 〈 0. 05）. The two groups′ operative duration[（113. 6 ± 21. 0）min vs（110. 4 ± 18. 5） min],intra operative blood loss and postoperative complications（5 vs 8）difference was not statistically significant（P 〉 0. 05）. Conclusion LTCBDE is a safe,effective and feasible surgical method which has certain advantages in comparison to LBEPS group. LTCBDE can be considered as the first choice in the treatment of cholecystolithiasis and secondary choledocholithiasis.