腹腔镜胆囊切除术联合胆总管切开取石T管引流术治疗胆囊并胆总管结石的效果分析

Clinical effect of laparoscopic cholecystectomy combined with laparoscopic choledocholithotomy T-tube drainage in treatment of gallbladder and common bile duct stones

目的探讨腹腔镜胆囊切除术联合胆总管切开取石T管引流术(LC+LCHTD)在胆囊合并胆总管结石治疗中的应用效果。方法回顾性研究2013年1月-2016年1月在上海市奉贤区中心医院行手术治疗的胆囊合并胆总管结石患者共117例,其中行LC+LCHTD(LC+LCHTD组)57例,同期行传统开放胆囊切除术联合胆总管切开取石T管引流术(OC+OCHTD组)的患者60例。比较2组患者的手术时间、手术出血量、住院时间、住院费用和术后并发症发生情况,以及2组患者的术后相关生化指标的变化。不同时间点的测量值采用重复测量的方差分析,2组间比较采用t检验,计数资料组间比较采用χ~2检验。结果 LC+LCHTD组和OC+OCHTD组的手术时间差异无统计学意义(P>0.05);LC+LCHTD组患者的术中出血量、术后禁食水时间和术后住院时间均明显低于OC+LCHTD组(t值分别为11.765、2.978、5.876,P值均<0.05);LC+LCHTD组的术后24 h、3 d、7 d的疼痛VAS评分均显著低于OC+OCHTD组(t值分别为2.403、3.205、2.032,P值均<0.05);LC+LCHTD组患者的总住院费用显著高于OC+OCHTD组(t=5.664,P<0.001)。LC+LCHTD组的总并发症发生率和Alb下降幅度低于OC+OCHTD组(χ~2=4.173,t=10.766,P值均<0.05)。结论 LC+LCHTD在胆囊合并胆总管结石中的应用中,手术创伤和术后并发症明显减少,缩短了住院时间,加速术后康复。

Objectives To investigate the clinical effect of laparoscopic cholecystectomy （LC） combined with laparoscopic choledocholithot- omy T - tube drainage （LCHTD） in the treatment of gallbladder and common bile duct stones. Methods A retrospective analysis was per- formed for 117 patients with gallbladder and common bile duct stones who underwent surgical treatment in The Central Hospital of Fengxian District from January 2013 to January 2016, and among these patients, 57 underwent LC ＋ LCHTD （ LC ＋ LCHTD group） and 60 underwent open cholecystectomy （OC） combined with open choledocholithotomy T - tube drainage （OCHTD） （ OC ＋ OCHTD group）. The time of op- eration, intraoperative blood loss, length of hospital stay, hospital costs, and incidence of postoperative complications were compared be- tween the two groups, as well as the changes in related biochemical parameters after surgery. A repeated measures analysis of variance was used for comparison of values measured at different time points, the t - test was used for comparison of continuous data between groups, and the chi - square test was used for comparison of categorical data between groups. Results There was no significant difference in the time of operation between the LC ＋ LCHTD group and the OC ＋ OCHTD group （ P 〉 0.05 ）. Compared with the OC ＋ OCHTD group, the LC ＋ LCHTD group had significantly lower intraoperative blood loss, postoperative fasting time, and length of postoperative hospital stay （t = 11. 765, 2.978, and 5. 876, all P 〈 0.05 ）, a significantly lower visual analogue scale pain score at 24 homrs and 3 and 7 days after surgery （t = 2. 403, 3. 205, and 2. 032, all P 〈 0. 05 ）, and significantly higher total hospital costs （ t = 5. 664, P 〈 0. 001 ）. The LC ＋ LCHTD group had a significantly lower incidence rate of total complications than the OC ＋ OCHTD group （x^2 = 4. 173, P 〈 0.05 ）, and the OC ＋ OCHTD group had a significantly greater reduetion in albumin than the LC ＋ LCHTD group （ t = 10. 766, P 〈 O. 05 ）. Conclusion In lhe treatment gallbladder and common bile duct stones, the patients treated with LC ＋ LCHTD have less surgical trauma and postoperative complications, a shorter length of hospital stay, and faster postoperative rehabilitation, compared with those treated with OC ＋ OCtt＇FD.