腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的疗效分析

Clinical effect of laparoscope combined with choledochoscope in one-stage treatment of patients with cholecystolithiasis and choledocholithiasis

目的探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石患者的疗效。方法选取安庆市第二人民医院2016年1月至2019年12月收治的胆囊结石合并胆总管结石患者40例,根据手术方式不同将其分为双镜联合组(20例)和传统开腹组(20例),双镜联合组患者行腹腔镜联合胆道镜手术,传统开腹组患者行开腹胆囊切除术+胆总管探查术。对两组患者的手术时间、术中出血量、术后排气时间、术后并发症和血液指标进行比较分析。结果双镜联合组患者术中出血量[(32.50±14.82)mL]、住院时间[(17.30±3.34)d]、并发症发生率[5%(1/20)]少于传统开腹组[(68.50±30.82)mL、(21.15±5.18)d、40%(8/20)],手术时间[(162.50±56.39)min]多于传统开腹组[(102.25±21.18)min],差异均有统计学意义(t=4.707、2.792、4.473,χ^2=2.692,均P<0.05);两组患者术后丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)和白蛋白(ALB)水平较术前均降低[双镜联合组(术前、术后):ALT(215.35±272.00)U/L、(44.60±44.63)U/L,ALT(38.80±43.23)μmol/L、(16.68±11.93)μmol/L,ALB(42.65±3.25)g/L、(39.58±3.78)g/L;传统开腹组(术前、术后):ALT(201.78±61.14)U/L、(61.14±48.35)U/L,TBIL(80.89±91.16)μmol/L、(40.24±53.61)μmol/L,ALB(39.37±6.81)g/L、(34.11±4.78)g/L],且双镜联合组明显优于传统开腹组,差异均有统计学意义(t=2.86、2.72、4.02;t=3.54、3.89、4.34;t=3.56、4、12、4.01,均P<0.05);两组外周血白细胞计数差异无统计学意义(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的临床疗效优于传统开腹手术。

Objective To explore the effect of laparoscope combined with choledochoscope in the treatment of cholecystolithiasis complicated with choledocholithiasis.Methods Totally 40 patients with cholecystolithiasis com-plicated with choledocholithiasis in the Second People's Hospital of Anqing from January 2016 to December 2019 were divided into double mirror combined group(20 cases)and open surgery group(20 cases)according to the operation mode.The patients in the double mirror combined group were treated by laparoscope combined with choledochoscope,and patients in the control group were treated by cholecystectomy and common bile duct exploration.The operation time,amount of bleeding,time to first flatus,postoperative complications and blood indicators were compared between the two groups.Results The amount of bleeding[(32.50±14.82)mL],the length of hospital stay[(17.30±3.34)d],and the incidence of complication[5%(1/20)]in the double mirror combined group were lower than those in the open surgery group[(68.50±30.82)mL,(21.15±5.18)d,40%(8/20)],the operation time[(162.50±56.39)min]in the double mirror combined group was longer than that in open surgery group[(102.25±21.18)min],there were statistically significant differences(t=4.707,2.792,4.473,χ^2=2.692,all P<0.05).The levels of alanine aminotransferase(ALT),total bilirubin(TBIL)and albumin(ALB)in the two groups after operation were lower than those pre-operation,which in the double mirror combined group were better than those in the open surgery group[double mirror combined group(preoperation and postoperation):ALT(215.35±272.00)U/L,(44.60±44.63)U/L,TBIL(38.80±43.23)μmol/L,(16.68±11.93)μmol/L,ALB(42.65±3.25)g/L,(39.58±3.78)g/L;open surgery group(preoperation and postoperation):ALT(201.78±61.14)U/L,(61.14±48.35)U/L,TBIL(80.89±91.16)μmol/L,(40.24±53.61)μmol/L,ALB(39.37±6.81)g/L,(34.11±4.78)g/L],there were statistically significant differences(t1=2.86,2.72,4.02;t2=3.54,3.89,4.34,t3=3.56,4,12,4.01,all P<0.05).There was no statistically significant difference in white blood cell count(P>0.05).Conclusion The clinical efficacy of laparoscope combined with choledochoscope in the treatment of cholecystolithiasis complicated with choledocholithiasis is better than open surgery.