腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石临床对比分析

Clinical comparative analysis of laparoscopic combined choledochoscope and traditional open surgery in the treatment of cholecystolithiasis complicated with choledocholithiasis

目的对比分析腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石患者的临床效果。方法选取诸暨市人民医院于2014年12月—2016年12月期间收治的胆囊结石合并胆总管结石患者92例,按照随机数字表法分为A组46例与B组46例。A组采用腹腔镜联合胆道镜治疗,B组采用开腹手术治疗。比较2组术中出血量、术后排气时间、手术时间及住院时间、手术成功率、术前和术后24 h肝功能指标变化。结果 A组术中出血量、术后排气时间及住院时间优于B组,差异有统计学意义(P<0.05),而2组手术时间比较差异无统计学意义(P>0.05);2组手术成功率均较高,差异无统计学意义(P>0.05);2组治疗后碱性磷酸酶(alkaline phosphatase,ALP)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)、门冬氨酸氨基转移酶(aspartate aminotransferase,AST)较治疗前增加(观察组:t=13.277、11.276、7.030、9.805,对照组:t=31.329、20.858、19.024、21.154,均P<0.05);A组治疗后ALP、ALT、TBIL、AST低于B组(t=21.720、11.340、11.588、11.277,均P<0.05)。结论腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石患者临床效果优于开腹手术,具有重要研究意义。

Objective To compare the clinical effectiveness of laparoscopic combined choledochoscope and traditional open surgery in the treatment of choleeystolithiasis complicated with eholedocholithiasis. Methods Total 92 patients with cholecystolithiasis combined with choledocholithiasis in our hospital between December, 2014 and December, 2016 were enrolled into this study and divided into group A and group B with 46 cases in each group according to the random number table method. Group A was treated with laparoseope combined with choledochoscopy, and group B was treated with open surgery. The amount of bleeding, time to first flatus, operation time, the length of stay, success rate of operation, and the changes of liver function indexes before and after the operation were compared between two groups. Results The in- traoperative blood loss, time to first flatus, operation time and length of stay in group A were better than those in group B （P 〈 0.05 ） ; The operation time of the two groups had no statistical difference （ P 〉 0.05 ）. The success rate of operation in both two groups was high, there was no statistical difference between them （ P 〉 0.05 ） ; The levels of ALP ALT, TBIL and AST increased after the treatment in both groups （ group A： t = 13. 277, 11. 276, 7. 030, 9. 805, group B ： t = 31.329, 20.858, 19.024, 21. 154, all P〈 0.05）. The levels of ALP, ALT, TBIL and AST in group A were lower than those in group B （t =21.720, 11.340, 11.588, 11.277, all P〈0.05）. Conclusion The clinical effect af lapa- roscopy combined with choledochoseopy in the treatment of cholecystolithiasis combined with choledocholithiasis is better than open surgery. The research significance deserves attentions.