腹腔镜联合胆道镜下钬激光碎石术与胆总管切开取石术治疗老年胆管结石的疗效对比

Comparison of effect of holmium laser lithotrity and cholangiotomy for stone removal under laparoscopy and choledochoscope on older cholangiolithiasis patients

目的对比分析腹腔镜联合胆道镜下钬激光碎石术与胆管切开取石术治疗老年肝内外胆管结石的疗效。方法来自2015年6月至2017年10月在郑州市人民医院肝胆外科收治的老年胆管结石患者127例,根据手术方式将其分为腹腔镜下胆道镜钬激光碎石组(观察组,65例),腹腔镜下胆总管切开探查取石组(对照组,62例)。对比分析两组患者围手术期指标、并发症及术后复发情况,分析比较两组患者术后应激反应指标血糖及CRP的差异。结果两组患者在手术时间、术中出血量、术后首次排气时间及住院时间等方面无统计学差异(P> 0. 05);观察组术后并发症发生率以结石残留率均明显低于对照组(6. 2%vs 17. 7%,3. 1%vs 12. 9%);术后对照组的应激反应指标均明显高于观察组(P <0. 05);两组患者术后随访均未发现结石复发。结论胆道镜钬激光碎石术相比腹腔镜下胆总管切开探查术术后并发症及残石率低、应激反应较低,疗效更好且安全性高,值得在临床上推广使用。

Objective To compare the curative effect of holmium laser lithotripsy and cholangiotomy under laparoscopy combined with choledochoscope on older intraphepatic and extrahepatic cholangiolithiasis patients. Methods Totally127 older patients with cholangiolithiasis treated in Zhengzhou People＇s Hospital during Jun. 2015 to Oct. 2017 were collected. According to the surgical procedures,the patients were divided into the laparoscopy combined with choledochoscope holmium laser lithotripsy group（ observation group,n = 65） and laparoscopy combined with choledocholithotomy group（ control group,n = 62）. The perioperative conditions,postoperative complications and recurrence of the two groups were compared,and the stress response indexes： blood glucose and CRP were compared between the two groups before and after treatment. Results There was no difference in the operation time,intraoperative blood loss,postoperative evacuation time and hospitalization time between the two groups（ P〉0. 05）; Both the incidence of complications and rate of residual stone in observation group were significantly lower than those in control group（ 6. 2% vs17. 7%,3. 1% vs 12. 9%）. The stress response indexes after operation in the control group were significantly higher than observation those in group（P〈0. 05）,and there was no recurrence cases in the two groups. Conclusion The postoperative complications rate,stone residual rate and the stress response of holmium laser lithotripsy were lower than choledochotomy under laparoscopy combined with choledocholithotomy,which meant more effective and safe and worthy of being widely applied in clinic.