腹腔镜联合胆道镜胆总管探查术与传统开腹胆囊切除联合胆总管探查术治疗胆囊结石合并胆总管结石的效果对比

Comparison of effects between laparoscopy and traditional open cholecystectomy in combination with common bile duct exploration for cholecystolithiasis and choledocholithiasis

目的比较腹腔镜联合胆道镜胆总管探查术与传统开腹胆囊切除联合胆总管探查术治疗胆囊结石合并胆总管结石的临床效果。方法选择2015年7月至2017年2月晋中市中医院收治的200例胆囊结石合并胆总管结石患者作为研究对象,将接受传统开腹胆囊切除联合胆总管探查术治疗的100例患者纳入对照组,将接受腹腔镜联合胆道镜胆总管探查术治疗的100例患者纳入观察组。比较两组患者结石清除率、术后1年随访复发情况、手术情况、肝功能指标变化以及并发症发生情况。结果两组均成功清除了胆总管结石,结石清除率均为100%;随访1年,观察组结石复发率为2.00%,对照组结石复发率为3.00%,两组结石清除率及复发率比较差异未见统计学意义(P>0.05)。观察组手术时间、术中出血量、术后肛门排气时间、术后下床时间以及住院总天数均少于对照组,差异有统计学意义(P<0.05);术后观察组碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、天门冬氨酸氨基转移酶(AST)水平低于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率(7.00%)低于对照组(23.00%),差异有统计学意义(P<0.05)。结论腹腔镜联合胆道镜胆总管探查术相对开腹胆囊切除联合胆总管探查手术治疗胆囊结石合并胆总管结石,手术创伤小,术后并发症较小,对患者肝脏功能损害较小,安全可靠。

Objective To compare the effects between laparoscopy and traditional open cholecystectomy in combination with common bile duct exploration for cholecystolithiasis and choledocholithiasis.Methods A total of 200 patients with cholecystolithiasis complicated with choledocholithiasis admitted to Jinzhong Hospital of Traditional Chinese Medicine from July 2015 to February 2017 were selected as research subjects.Of them,100 patients who received traditional open cholecystectomy combined with common bile duct exploration were enrolled in control group,and 100 patients who underwent laparoscopy combined choledochoscopic common bile duct exploration were enrolled in observation group.The stone removal rate,follow-up recurrence rate at one year after operation,surgical status,liver function indexes and incidence of complications were compared between the two groups.Results The choledocholithiasis was successfully removed in the two groups with stone removal rate of 100%;after 1 year of follow-up,the recurrence rate of stone was 2.00%in observation group and 3.00%in control group,and there was no statistically significant difference in stone clearance rate or recurrence rate between the two groups(P>0.05).The operative time,intraoperative blood loss,postoperative anal exhaust time,postoperative ambulation time and total hospital stay in observation group were shorter than those in control group(P<0.05).After treatment,the levels of alkaline phosphatase(ALP),alanine aminotransferase(ALT)and total bilirubin(TBIL)and aspartate aminotransferase(AST)in observation group were lower than those in control group(P<0.05).The incidence of postoperative complications in observation group was lower than that in control group(7.00%vs.23.00%),P<0.05.Conclusions Compared with open cholecystectomy combined with common bile duct exploration,laparoscopy combined with common bile duct exploration for cholecystolithiasis and choledocholithiasis has less trauma,fewer postoperative complications,and less damage to liver function,so it is safe and reliable.