腹腔镜治疗胆总管结石伴胆囊结石的最佳术式研究

Optimal Operation of Laparoscope in Treating Choledocholithiasis Combined with Gallbladder Stone

目的探讨胆总管结石伴胆囊结石的最佳腹腔镜治疗方法。方法选取2014年1月—2015年6月包头医学院第二附属医院收治的胆总管结石伴胆囊结石患者254例,患者行胆总管探查术,根据结石情况分为腹腔镜下经胆囊管取石术(LTSE)组和腹腔镜下胆总管切开取石术(LCBDE)组,LCBDE组患者经胆总管清除结石手术后被随机分配接受胆管一期缝合(一期缝合亚组)或T管引流(T管引流亚组)。比较LTSE组和LCBDE组患者结石清除率、并发症发生情况以及住院费用、住院时间等。结果 14例患者转行开放性手术,172例患者接受LTSE,68例患者接受LCBDE。LCBDE患者中,一期缝合34例,T管引流34例。LTSE组和LCBDE组性别、年龄、急性胆囊炎、结石清除率比较,差异均无统计学意义(P>0.05);LTSE组结石数量、结石直径小于LCBDE组,手术时间、住院费用、住院时间短于LCBDE组(P<0.05)。一期缝合亚组和T管引流亚组性别、年龄、急性胆囊炎、结石数量、结石直径、结石清除率比较,差异均无统计学意义(P>0.05);一期缝合亚组手术时间、住院费用、住院时间短于T管引流亚组(P<0.05)。LTSE组胆管并发症发生率低于LCBDE组(χ~2=6.461,P=0.011);两组其他并发症发生率比较,差异无统计学意义(χ~2=3.682,P=0.055);LTSE组总并发症发生率低于LCBDE组(χ~2=11.332,P=0.001)。结论对于胆总管结石伴胆囊结石患者,LTSE应是首选治疗,较LCBDE更安全有效,费用低。对于行LCBDE者,一期缝合简单易行,可替代T管引流。

Objective To investigate the optimal therapeutic method of laparoscope in treating choledocholithiasis combined with gallbladder stone.Methods Two hundred and fifty-four patients with choledocholithiasis combined with gallbladder stone who received treatment in the Second Affiliated Hospital of Baotou Medical College from January 2014 to June2015 were selected.Patients underwent common bile duct exploration were divided into laparoscopic stone extraction（ LTSE）group and laparoscopic choledochotomy（ LCBDE） group.Patients in LCBDE group after bile duct removal surgery were randomly assigned to primary suture subgroup or T-tube drainage subgroup.The stone clearance rate,occurrence of complication,hospitalization cost and length of stay of patients in two groups were compared.Results Fourteen patients underwent open surgery,172 patients received LTSE,and 68 patients received LCBDE.Among patients in LCBDE,34 cases accepted primary suture and 34 cases T tube drainage.There was no significant difference in gender,age,acute cholecystitis and stone clearance rate between LTSE group and LCBDE group（ P〈0.05）; the number of stones and diameter of the stone in LTSE group were less than those in LCBDE group,and the operation time,hospitalization cost and length of stay in LTSE group were shorter than those in LCBDE group（ P〈0.05）.There was no significant difference in gender,age,acute cholecystitis,number of stones,diameter of stones and clearance rate of stone between primary suture subgroup and T-tube drainage subgroup（ P〈0.05）; the operation time,hospitalization cost and length of stay in primary suture subgroup were shorter than those in T-tube drainage subgroup（ P〈0.05）.The incidence rate of biliary complications in LTSE group was lower than that in LCBDE group（ χ~2= 6.461,P = 0.011）; there was no significant difference in the incidence rate of other complications between the two groups（ χ~2= 3.682,P = 0.055）; the overall incidence rate of complications in LTSE group was lower than that in LCBDE group（ χ~2= 11.332,P = 0.001）.Conclusion For patients with choledocholithiasis combined with gallbladder stone,LTSE should be the preferred treatment plan as it is of low cost and safer and more effective than LCBDE.For patients underwent LCBDE,primary suture is more simple,which can replace T-tube drainage approach.