经胆囊管路径两镜或三镜并一期缝合治疗胆囊结石并继发性胆总管结石的疗效分析

Efficacy analysis of primary closure with two or three endoscopes through cystic duct for treatment of gallbladder stone with secondary common bile duct stones

目的探讨经胆囊管路径两镜(腹腔镜+胆道镜)或三镜(腹腔镜+胆道镜+十二指肠镜)联合并一期缝合治疗胆囊结石并继发性胆总管结石的临床疗效及两种术式的优缺点。方法回顾性收集2017年1月至2018年12月期间成都市第二人民医院肝胆外科收治并行经胆囊管路径两镜或三镜联合胆总管探查取石术+一期缝合术的83例胆囊结石并继发性胆总管结石患者的临床资料,其中41例行经胆囊管路径两镜联合胆总管探查取石术+一期缝合术(两镜组),42例行经胆囊管路径三镜联合胆总管探查取石术+经腹置入鼻胆管引流术+一期缝合术(三镜组)。结果两镜组和三镜组的性别、年龄及术前胆总管直径、术前基础疾病等比较差异无统计学意义(P>0.05)。83例患者的手术均成功且术后恢复情况良好,2组患者的手术成功率、结石清除率、术后1 d腹腔引流量、拔除引流管时间和住院时间比较差异均无统计学意义(P>0.05),三镜组的手术时间、术中出血量和术后轻型胰腺炎发生率明显高于两镜组(P<0.05),但术后肝功能恢复情况优于两镜组(P<0.05)。结论对于胆囊结石合并继发性胆总管结石患者,在严格掌握手术适应证情况下,经胆囊管路径两镜或三镜联合胆总管探查取石+一期缝合术均安全、可行,但在具体选择两镜还是三镜联合应根据患者术前一般情况和术中探查情况来决定。

Objective To investigate clinical efficacy and advantages and disadvantages of primary closure with two endoscopes(1 aparoscope+choledochoscope) or three endoscopes(laparoscope+choledochoscope+duodenoscope)through the cystic duct for treatment of gallbladder stone with secondary common bile duct(CBD) stones. Methods The clinical data of 83 patients with gallbladder stones with secondary CBD stones treated by two or three endoscopes combined with CBD exploration and lithotomy and primary closure through cystic duct from January 2017 to December 2018 in the Chengdu Second People’s Hospital were collected retrospectively. Among them, 41 patients were treated by two endoscopes mode(two endoscopes group), 42 cases were treated by three endoscopes mode(three endoscopes group). Results There were no significant differences in the general conditions such as the gender, age,preoperative diameter of CBD, chronic diseases, etc. between the two and three endoscopes group(P>0.05). All 83 cases underwent the operations successfully and recovered well. The success rate of operation, stone clearance rate, drainage volume of abdominal drainage tube on day 1 after the operation, time of abdominal drainage tube removal after the operation, and hospitalization time had no significant differences between these two groups(P>0.05). The time of operation, intraoperative bleeding volume, and the postoperative pancreatitis rate in the three endoscopes group were significantly more(or higher) than those in the two endoscopes group(P<0.05), but the condition of liver function recovered after the operation was better than that in the two endoscopes group(P<0.05). Conclusions With the strict control of the operation indications, it is safe and feasible to use two or three endoscopes through the cystic duct pathway and primary closure of CBD for treatment of gallbladder stone with secondary CBD stones. However, the choice of operative methods of two or three endoscopes should be based on the general situation of the patients before and during the operation.