腹腔镜联合胆道镜治疗胆总管结石两种术式的疗效对比研究

The Clininal Comparative Study of Two Kinds of Laparoscopy-choledeochoscopic Common Bile Duct Exploration and Lithotomy in the Treatment of Choledocholithiasis

目的探讨腹腔镜联合胆道镜经胆囊管胆总管探查、取石一期缝合术(A术式)与腹腔镜胆总管探查取石、T管引流术(B术式)治疗胆总管结石的临床疗效对比。方法选取2016年6月至2017年12月收治的90例胆囊结石合并胆总管结石患者。根据术式随机分为A组(46例)和B组(44例),比较两组患者临床相关指标,术后结石残余率,结石复发率及术后并发症发生率。结果两组患者手术时间有统计学差异(P<0.05)。A组术后引流量、引流管拔除时间、术后1周VAS评分、首次肛门排气时间、并发症发生率及住院时间明显优于B组,差异有统计学意义(P<0.05)。术后随访11~17个月,两组患者均未出现结石残留、胆道狭窄并发症。结论腹腔镜联合胆道镜经胆囊管胆总管探查、取石一期缝合术,相较于腹腔镜胆总管探查取石、T管引流术治疗胆囊结石合并胆总管结石可有效缩短住院时间,减少术后并发症及住院费用,符合加速康复外科理念,是安全、可行的。

Objective The study was aimed to compare the clinical efficacy of single-stage management with combined laparoscopy-choledeochoscopic transcystic common bile duct exploration and lithotomy(type A)with laparoscopic common bile duct exploration and lithotomy and T-tube drainage(type B)for the treatment of common bile duct stones.Methods 90 patients with cholecystolithiasis complicated with common bile duct stones admitted from June 2016 to December 2017 were selected.According to the operative methods,patients were randomly divided into group A(46 cases)and group B(44 cases),and the clinical indicators,residual rate of postoperative stones,recurrence rate of stones and incidence of postoperative complications were analysed between the two groups.Results There was a statistically significant difference in operation time between the two groups(P<0.05).Postoperative drainage volume,drainage tube removal time,VAS score of one week after surgery,first anal exhaust time,complication rate and hospital stay in group A were better than group B,with statistically significant differences(P<0.05).The patients in the two groups were followed up for 11 to 17 months after the operation.Conclusion Compared with laparoscopic exploration of the stones of common bile duct and T-tube drainage treatment of gallbladder stone with common bile duct calculi,laparoscopy combined with choledochoscope for common bile duct exploration and single-stage extraction suture,can effectively shorten the length of hospital stay,reduce the postoperative complications and hospitalization costs,which conforms to the conception of enhanced recovery after surgery,and it is safe and feasible.