腹腔镜下胆总管切开取石术与经胆囊管取石术治疗胆总管结石伴胆囊结石患者疗效分析

Efficacy of laparoscopic common bile duct exploration and transcystic stone extraction in treatment of patients with choledocholithiasis and cholecystolithiasis

目的探讨胆总管结石伴胆囊结石患者治疗的最佳腹腔镜微创术式选择。方法2013年6月~2016年6月本院收治的胆总管结石伴胆囊结石患者500例,其中234例患者接受腹腔镜下胆总管切开取石(LCBDE)术,266例接受腹腔镜下经胆囊管取石术(LTSE)。在LCBDE组,采用腹腔镜胆囊切除术(LC)联合LCBDE和T管引流,在LTSE组,采用LC联合LTSE。比较两组治疗后结石清除率、手术时间、术后首次排气时间和住院时间、术后并发症和结石复发率。结果LCBDE组结石数量为(4.6±1.7)个,显著多于LTSE组的(3.1±2.4)个(P<0.05),结石直径为(11.8±5.4)mm,显著大于LTSE组的(5.2±2.2)mm(P<0.05),手术时间、首次肛门排气时间和住院时间分别为(114±27)min、(3.4±1.3)d和(7.1±3.2)d,显著长于LTSE组的(73±21)min、(2.2±0.9)d和(3.5±1.8)d(P<0.05);LCBDE组结石清除率为94.9%,与LTSE组的94.7%比,差异无统计学意义(P>0.05);LCBDE组并发症发生率为24.4%,显著高于LTSE组的10.9%(P<0.05);在随访1年期间,LCBDE组结石复发率为4.7%,显著高于LTSE组的1.5%(P<0.05)。结论采用LC联合LTSE术治疗胆总管结石伴胆囊结石患者恢复较快,可明显缩短住院时间,且并发症发生率和远期结石复发率较低。

Objective To explore the optimal laparoscopic minimally invasive surgery for the treatment of patients with choledocholithiasis and cholecystolithiasis.Methods 500 patients with choledocholithiasis and cholecystolithiasis were recruited in our hospital between June 2013 and June 2016,and 234 of them received laparoscopic common bile duct exploration(LCBDE)and 266 received laparoscopic transcystic stone extraction(LTSE).The patients in LCBDE group was treated with laparoscopic cholecystectomy(LC)plus LCBDE and T tube drainage,and the patients in LTSE group was given LC and LTSE.The number of calculus,the diameters of stones,the removal rates of stones,the periods of operations,the times of first exhaust,the hospital stays,and the postoperative complications and recurrence rates of gallstones were compared between the two groups.Results The number of stones in the LCBDE group was greater than that in the LTSE group[(4.6±1.7)vs.(3.1±2.4),P<0.05],and the stone diameter in the LCBDE group was larger than that in the LTSE group[(11.8±5.40)mm vs.(5.2±2.2)mm,P<0.05];the operative time,first exhaust time and hospital stays were(114±27)min,(3.4±1.3)d and(7.1±3.2)d,respectively in the LCBDE group,much longer than those in the LTSE group[(73±21)min,(2.2±0.9)d and(3.5±1.8)d,respectively,P<0.05];there was no significant difference in the removal rates of stones between the LCBDE group and the LTSE group(94.9%vs.94.7%,P>0.05);the total incidence rate of complications was 24.4%in the LCBDE group,significantly higher than that in the LTSE group(10.9%,P<0.05);during the 1 year of follow-up,the stone recurrence rate in the LCBDE group was 4.7%,much higher than that in the LTSE group(1.5%,P<0.05).Conclusions The application of LC plus LTSE in treatment of patients with choledocholithiasis and cholecystolithiasis have a good efficacy with fast recovery,short hospital stays,and low morbidity of complications and long-term stone recurrence.