开腹与腹腔镜联合胆道镜治疗胆总管结石的疗效分析

Efficacy and prognosis of T-tube drainage after laparoscopic combined with cholangioscopic choledochotomy removal for choledocholithiasis

目的分析治疗胆总管结石采用腹腔镜下联合胆道镜胆总管切开取石后行T管引流的疗效和预后情况。方法回顾性分析2015年3月～2018年3月72例到我院治疗胆总管结石患者资料。根据患者接受手术方法不同分为两组,接受开腹手术32例患者为开腹组,接受腹腔镜下联合胆道镜胆总管切开取石后行T管引流40例患者为腹腔镜组。比较两组患者术中指标,术后康复相关指标,术后谷草转氨酶(AST)、总胆红素(TBIL)以及谷丙转氨酶(ALT)水平,术后并发症发生率。结果腹腔镜组患者手术时间、术中出血量、通气时间、进食时间、住院时间均显著低于开腹组(P <0. 05),仅住院费用显著高于开腹组(P <0. 05);腹腔镜组患者术后AST、TBIL以及ALT水平明显低于开腹组患者(P <0. 05);腹腔镜组和开腹组并发症发生率为10%和31. 25%,并发症比较差异具有统计性(P <0. 05)。结论腹腔镜下联合胆道镜胆总管切开取石后行T管引流治疗胆总管结石效果较好,并发症发生较少。

Objective To analyze the efficacy and prognosis of T-tube drainage after laparoscopic combined with cholangioscopic choledochotomy removal for choledocholithiasis. Methods The date from 72 patients for the treatment of choledocholithiasis from March 2015 to March 2018 in our hospital were analyzed. According to the different surgical procedures, the patients were divided into two groups, 32 patients with open surgery were in the open surgery group, the 40 patients with T-tube drainage after laparoscopic combined with cholangioscopic choledochotomy removal were in the laparoscopic group. The intraoperative indexes, postoperative rehabilitation related indexes, postoperative aspartate aminotransferase ( AST), total bilirubin ( TBIL), alanine aminotransferase ( ALT) levels, and incidence rate of postoperative complications were compared between the two groups. Results The operative time, intraoperative blood loss, ventilation time, eating time, and hospital stay were significantly lower in the laparoscopic group than those in the open surgery group (P < 0. 05 ), the hospitalization cost was significantly higher than that in the open surgery group ( P < 0. 05 ). The AST, TBIL and ALT levels in the laparoscopic group were significantly lower than those in the open surgery group ( P < 0. 05 ). The complication rate was 10% and 31.25% in the laparoscopic and open surgery group.( P < 0. 05). Conclusion T-tube drainage after laparoscopic combined with cholangioscopic choledochotomy removal for choledocholithiasis is better and less complications occur.