胆囊并发胆总管结石患者的微创外科治疗研究

Minimally invasive surgical treatment for gallbladder patients with common bile duct stones

目的探究胆囊并发胆总管结石患者的微创外科治疗。方法选取2013年1月-2018年1月该院收治的92例胆囊并发胆总管结石患者为研究对象,采用随机数字表法将患者分为对照组(n=46)和观察组(n=46)。两组患者中存在胰腺炎的患者先行控制腹膜炎,对照组患者行腹腔镜胆囊切除术(LC)联合胆总管探查取石术(LCBDE),观察组患者行十二指肠乳头括约肌切开取石术(EST),术后3 d行LC治疗。比较两组患者围术期情况、费用情况和并发症情况。结果两组患者均未出现中转开腹手术情况,观察组患者的手术时间、止痛药使用率、住院时间均低于对照组患者,耗材费用和住院总费用多于对照组患者,差异具有统计学意义(P<0.05);两组患者的术中出血量、术后排气时间和手术费用比较差异无统计学意义(P>0.05)。观察组患者各项并发症总发生率为6.51%低于对照组患者的19.53%,差异具有统计学意义(P<0.05)。结论胆囊并发胆总管结石患者控制腹膜炎后行EST+LC治疗较LC+LCBDE治疗能够缩短手术时间,减轻术后疼痛,降低并发症发生率,缩短住院时间,但所需费用较高。

Objective To explore the minimally invasive surgical treatment for gallbladder patients with common bile duct stones.Methods Twenty-two cases of cholecystolithiasis complicated with common bile duct stones treated from January 2013 to January 2018 were selected.The patients were divided into control group(n=46)and observation group(n=46).Patients with pancreatitis in both groups had first control of peritonitis.Patients in the control group(LC+LCBDE)underwent laparoscopic cholecystectomy combined with common bile duct exploration.Patients in the observation group(EST+LC)underwent duodenal sphincterotomy.Stone removal was performed and laparoscopic cholecystectomy was performed 3 days after surgery.The perioperative conditions,cost,and complications were compared between the two groups.Results No conversion to laparotomy was observed in both groups.The observation time,the use of analgesics,and length of hospital stay in the observation group were all lower than those in the control group.Consumable costs and hospitalization expenses were higher than those in the control group.The difference was statistically significant(P<0.05);There was no significant difference in intraoperative blood loss,postoperative venting time,and surgical cost between the two groups(P>0.05).The total incidence of complications in the observation group was 6.51%lower than that in the control group,19.53%,with a statistically significant difference(P<0.05).Conclusion Compared with LC+LCBDE,the treatment of peritonitis with gallbladder complicated with common bile duct stones can reduce the operation time,relieve postoperative pain,reduce the incidence of complications and shorten the hospital stay,but the cost is higher.