三种不同微创方式治疗胆总管结石不伴有胆囊结石的疗效观察

Curative Effect of Three Different Minimally Invasive Methods for the Treatment of Common Bile Duct Stones without Gallstones

目的:探究不同微创方式治疗胆总管结石不伴有胆囊结石的疗效。方法:回顾性分析96例胆总管结石患者的临床资料,按照术式的不同分为A、B、C组三组,其中A组行腹腔镜下胆总管切开取石及一期缝合术,B组行胆囊切除术、胆总管切开取石术及一期缝合术;C组行胆囊切除术、胆总管切开取石术及T管引流术,比较患者围手术期指标及并发症发生情况。结果:A组患者术中出血量显著低于B、C两组(P<0.05),C组术后排气或排便时间、住院时间显著长于A、B两组,差异具统计学意义(P<0.05);三组患者术后结石残留、结石复发及术后并发症发生均无显著性差异(P>0.05)。结论:3种微创术式各自具有其优缺点,对于具有保留胆囊及一期缝合术适应症的患者,建议行保留胆囊及一期缝合术。

Objective: To investigate the curative effect of different minimally invasive methods for the treatment of common bile duct stones without gallstones. Methods: Retrospective analysis of clinical data of 96 patients with common bile duct stones were performed,Patients were divided into groups A,B,and C according to different surgical procedures. Group A undergoing laparoscopic choledocholithotomy,primary suture,group B undergoing laparoscopic cholecystectomy ,laparoscopic choledocholithotomy ,primary suture and group C undergoing laparoscopic cholecystectomy ,laparoscopic primary ,T tube drainage. The intraoperative blood loss,surgical time,postoperative exhaust time,incidence of postoperative complications,hospitalization time and costs were compared among the three groups. Results: The intraoperative blood loss of group A was significantly less than that of group B and group C (P<0.05). The exhaust or defecation time and hospitalization time of group C was significantly longer than that of group A and group B (P<0.05). There was no significant difference in the incidence of postoperative residual stones,stone recurrence or postoperative complications among the three groups (P>0.05). Conclusion: The three minimally invasive procedures have their own advantages and disadvantages. For patients with indications for preservation of gallbladder and primary suture,it is recommended to preserve gallbladder and use primary suture.