胆总管结石合并胆囊良性疾病患者微创术式选择分析

Selection of minimally invasive surgery for patients with choledocholithiasis and benign gallbladder diseases

目的探讨胆总管结石合并胆囊良性疾病患者不同微创术式治疗效果。方法收集2013年1月~2017年6月医院收治的60例胆总管结石合并胆囊良性疾病患者的临床资料,其中接受腹腔镜胆总管探查术(LCBDE)32例(LCBDE组),接受内镜下十二指肠乳头括约肌切开术(EST)+腹腔镜胆囊切除术(LC)28例(EST+LC组),比较患者围术期情况、手术并发症发生率及术后恢复情况。结果 (1)LCBDE组手术成功率为96.88%,EST+LC组手术成功率为89.29%,两组手术总成功率比较差异无统计学意义(P>0.05)。(2)LCBDE组住院时间短于EST+LC组,住院费用低于EST+LC组(P<0.05)。(3)术后不同时间LCBDE组视觉模拟评分(VAS)均低于EST+LC组(P<0.05),其应用镇痛药物所占比例低于EST+LC组(P<0.05)。(4)两组术后结石残留、复发率比较差异无统计学意义(P>0.05)。结论 LCBDE与EST+LC治疗胆总管结石合并胆囊良性疾病均有肯定的疗效,术后并发症发生率相近,均微创,安全,但LCBDE术可缩短患者住院时间,减少术后疼痛程度,减少医疗费用。

Objective To investigate the therapeutic effects of different minimally invasive surgeries in patients with choledo- cholithiasis and benign gallbladder diseases. Methods The clinical data of 60 patients with choledocholithiasis and benign gallbladder diseases treated in the hospital during the period from January 2013 to June 2017 were collected. Among the patients, 32 patients were treated by laparoscopic common bile duct exploration （LCBDE） （ LCBDE group） and 28 patients were treated by endoscopic sphincter- otomy （EST） and laparoscopic cholecystectomy （LC） （EST ＋ LC group）. The perioperative condition, the incidence of surgical com- plications and postoperative recovery were compared. Results （1）There was no significant difference in the success rate of surgery be- tween the two groups （96.88% vs 89.29% ） （P 〉0. 05）. （2）The hospitalization time of LCBDE group was shorter than that of EST ＋ LC group, and the hospitalization costs was less than that of EST ＋ LC group （P 〈 0.05 ）. （3）Scores of visual analogue scale （VAS） in LCBDE group at different time after surgery were lower than those in EST ＋ LC group （ P 〈 0. 05 ）, and the proportion of using analgesic drugs was lower than that in EST ＋ LC group （P 〈 0. 05 ）. （4）There was no significant difference between the two groups in residual stones and recurrence rate （ P 〉 0. 05 ）. Conclusion Both of LCBDE and EST ＋ LC are effective in the treatment of choledocholithia- sis and benign gallbladder diseases, and the incidence rates of postoperative complications are similar. The two surgeries are minimally invasive and safe, but LCBDE can shorten the hospitalization time, reduce postoperative pain and reduce medical costs.