腹腔镜联合胆道镜下钬激光碎石取石术治疗肝外胆管结石的临床效果

Clinical effect of laparoscopic combined with choledochoscopic holmium laser lithotripsy in the treatment of extrahepatic bile duct stones

目的探讨腹腔镜联合胆道镜下钬激光碎石取石术治疗肝外胆管结石的临床效果。方法选取2017年6月至2020年6月我院收治的114例肝外胆管结石患者为研究对象,根据手术方式不同将其分为对照组(57例,腹腔镜下胆管切开取石术)和观察组(57例,腹腔镜联合胆道镜下钬激光碎石取石术)。比较两组的治疗效果。结果观察组手术时间、取石时间、胃肠功能恢复时间、住院时间均短于对照组,术中出血量少于对照组,结石清除率高于对照组(P<0.05)。术后,两组TBIL、TBA、CB、UCB、ALT、AST、AKP、GGT水平均较术前降低,且观察组低于对照组(P<0.05)。术后12、24 h,观察组VAS评分均低于对照组(P<0.05)。观察组并发症总发生率低于对照组,治疗总有效率高于对照组(P<0.05)。结论腹腔镜联合胆道镜下钬激光碎石取石术治疗肝外胆管结石疗效显著,能有效优化手术及预后指标,降低患者血清胆汁生化指标和肝功能指标水平,减轻疼痛,降低并发症发生率,促进术后康复。

Objective To investigate the clinical effect of laparoscopic combined with choledochoscopic holmium laser lithotripsy in the treatment of extrahepatic bile duct stones.Methods A total of 114 patients with extrahepatic bile duct stones admitted in our hospital from June 2017 to June 2020 were selected as the research objects.According to different operation methods,the patients were divided into control group(57 cases,laparoscopic choledocholithotomy)and observation group(57 cases,laparoscopic combined with choledochoscopic holmium laser lithotripsy).The therapeutic effects of the two groups were compared.Results The operation time,stone removal time,gastrointestinal function recovery time and hospitalization time in the observation group were shorter than those in the control group,the intraoperative blood loss volume was less than that in the control group,and the stone clearance rate was higher than that in the control group(P<0.05).After operation,TBIL,TBA,CB,UCB,ALT,AST,AKP,GGT levels in the two groups were lower than those before operation,and those in the observation group were lower than the control group(P<0.05).The VAS scores at 12 and 24 h after operation in the observation group were lower than those in the control group(P<0.05).The total incidence of complications in the observation group was lower than that in the control group,and the total effective rate of treatment was higher than that in the control group(P<0.05).Conclusion Laparoscopic combined with choledochoscopic holmium laser lithotripsy is effective in the treatment of extrahepatic bile duct stones,it can effectively optimize the operation and prognosis indexes,reduce the serum bile biochemical indexes and liver function indexes,relieve pain,reduce the incidence of complications,and promote postoperative rehabilitation.