腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床效果

Clinical effects of laparoscopic and choledochoscopic surgery in treatment of gallstones combined with common bile duct stones

目的观察腹腔镜联合胆道镜手术治疗胆囊结石合并胆总管结石的临床效果。方法选取2014年7月‐2016年8月该院诊治的胆囊结石合并胆总管结石患者88例,采用随机数字表法将所选患者分为观察组和对照组,各44例。对照组行传统开腹术治疗,观察组行腹腔镜联合胆道镜手术治疗。对比两组手术指标、并发症发生情况以及疾病复发情况。结果观察组手术时间(138.77±10.26)min,略低于对照组的(140.67±12.13)min,差异无统计学意义(P>0.05);观察组出血量(52.06±7.49)ml、术后肛门排气时间(2.45±0.62)d以及住院时间(7.87±1.22)d,均少于对照组,差异具有统计学意义(P <0.05);观察组切口感染、胆道感染、胆漏、残余结石、反流性食管炎及胰腺炎等并发症总发生率(6.82%)较对照组(22.73%)低,差异具有统计学意义(P <0.05);观察组疾病复发率(2.27%)略低于对照组(4.55%),差异无统计学意义(P>0.05)。结论针对胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜治疗,可有效减少患者手术出血,促进术后肠胃功能恢复,缩短患者住院时间,且可有效减少并发症发生,利于预后。

【Objective】To observe the clinical effects of laparoscopic and choledochoscopic surgery in treatment of gallstones combined with common bile duct stones（CBDS）.【Methods】Eighty-eight cases of gallstones combined with CBDS treated in our hospital from July 2014 to August 2016 were selected, and they were divided into observation group and control group by the random number table, 44 cases in each group. Control group was given traditional open surgery, while observation group was treated with laparoscopic and choledochoscopic surgery. The surgical indexes, complications and recurrence were compared between the two groups.【Results】The operation time of observation group [（138.77±10.26） min] was slightly shorter than control group [（140.67±12.13） min], but there was no statistical difference（P 0.05）; the bleeding volume, postoperative anal exhaust time and hospital stays in observation group [（52.06±7.49） ml,（2.45±0.62） d,（7.87±1.22） d] were less than control group（P 0.05）; the total incidence of incision infection, biliary tract infection, bile leakage, residual stone, reflux esophagitis, pancreatitis in observation group（6.82%） was lower than control group（22.73%）（P 0.05）; the recurrence rate of observation group（2.27%） was slightly lower than control group（4.55%）, but there was no statistical difference（P 0.05）.【Conclusion】Laparoscopic and choledochoscopic surgery in treatment of gallstones combined with CBDS can reduce bleeding, promote recovery of postoperative stomach function, shorten hospital stays, reduce complications and facilitate prognosis.