腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石的临床效果

Clinical effect of laparoscopy combined with choledochoscope and traditional laparotomy in the treatment of cholecystolithiasis with common bile duct stones

目的比较腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石的临床效果。方法120例胆囊结石合并胆总管结石患者,按随机数字表法分为对照组和研究组,各60例。对照组采取传统开腹胆囊切除与胆总管取石手术治疗,研究组采取腹腔镜联合胆道镜进行胆囊切除与胆总管取石手术治疗。比较两组患者手术时间、术中失血量、术后恢复排气时间、术后1 d时视觉模拟评分法(VAS)评分、住院时间、术后并发症发生情况及术后1年内复发情况。结果研究组术中失血量(36.5±5.8)ml少于对照组的(87.6±8.6)ml,术后恢复排气时间(47.5±5.6)h、住院时间(8.2±2.0)d均短于对照组的(83.5±8.5)h、(14.6±2.5)d,术后1 d时VAS评分(3.5±0.8)分低于对照组的(6.7±1.8)分,差异有统计学意义(P<0.05);两组手术时间比较差异无统计学意义(P>0.05)。研究组术后并发症发生率3.33%低于对照组的15.00%,差异有统计学意义(P<0.05)。两组术后1年内复发率比较差异无统计学意义(P>0.05)。结论腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石,可以有效减少术中失血量,降低术后疼痛程度与并发症发生率,利于患者康复。

Objective To compare the clinical effect of laparoscopy combined with choledochoscope and traditional laparotomy in the treatment of cholecystolithiasis with common bile duct stones.Methods A total of 120 patients with cholecystolithiasis and common bile duct stones were divided by random number table method into control group and research group,with 60 cases in each group.The control group was treated with traditional laparotomy for cholecystolithiasis with common bile duct stones,and the research group was treated with laparoscopy combined with choledochoscope for cholecystolithiasis with common bile duct stones.Comparison were made on operation time,intraoperative blood loss,recovery time of postoperative exhaust,visual analogue scale(VAS)score in postoperative 1 d,occurrence of postoperative complications and recurrence within 1 year between the two groups.Results The research group had less intraoperative blood loss as(36.5±5.8)ml than(87.6±8.6)ml in the control group,shorter recovery time of postoperative exhaust as(47.5±5.6)h and hospitalization time as(8.2±2.0)d than(83.5±8.5)h and(14.6±2.5)d in the control group,and lower VAS score in postoperative 1 d as(3.5±0.8)points than(6.7±1.8)points in the control group.Their difference was statistically significant(P<0.05).Both groups had no statistically significant difference in operation time(P>0.05).The research group had lower incidence of postoperative complications as 3.33%than 15.00%in the control group,and the difference was statistically significant(P<0.05).Both groups had no statistically significant difference in recurrence rate within 1 year(P>0.05).Conclusion For the treatment of cholecystolithiasis with common bile duct stones,laparoscopic combined with choledochoscopy can effectively reduce intraoperative blood loss,lower postoperative pain and complication rate,and facilitate rehabilitation.