胆囊切除患者应用腹腔镜胆总管探查疗法应对术后复发或残留胆总管结石的效果研究

Study on the Effect of Laparoscopic Common Bile Duct Exploration Therapy in Patients with Cholecystectomy in Response to Postoperative Recurrence or Residual Common Bile Duct Stones

目的研究探讨胆囊切除患者应用腹腔镜胆总管探查疗法应对术后复发或残留胆总管结石的效果。方法方便选取湖北省襄阳市建华路解放军第991医院2018年3月—2020年3月收治住院的80例胆囊切除术后复发或残留胆总管结石患者,按照不同的手术方式分别分配为观察组和对照组,各40例。对照组采用内镜逆行胰胆管造影术以及内镜下乳头切开术治疗,观察组采用腹腔镜胆总管探查疗法。记录并对比两组患者手术费用、手术时间、术后住院时间以及并发症、复发率。结果观察组手术费用(13.25±1.85)千元显著低于对照组(15.88±1.69)千元,观察组手术时间(68.95±14.1)min显著较对照组(120.21±25.13)min短,观察组术后住院时间(5.67±2.66)d显著短于对照组(7.86±2.31)d,差异有统计学意义(t=6.638、11.250、3.931,P<0.001);两组并发症发生率比较,差异无统计学意义(χ^(2)=0.180,P=0.671);观察组清石率100%显著高于对照组85%;观察组无复发率0%优于对照组15%,差异有统计学意义(χ^(2)=4.505、4.505,P=0.034)。结论腹腔镜胆总管探查疗法安全性高,手术费用低,值得临床推广与应用。

Objective To study the effect of laparoscopic common bile duct exploration therapy in patients with cholecystectomy to cope with recurrence or residual common bile duct stones after operation.Methods A total of 80 patients with recurrence or residual choledocholithiasis after cholecystectomy were conveniently selected from the 991 Hospital of the People's Liberation Army,Jianhua Road,Xiangyang City,Hubei Province from March 2018 to March 2020.They were assigned to the observation group and the control group according to different surgical methods,40 cases in each group.The control group was treated with endoscopic retrograde cholangiopancreatography and endoscopic papillectomy,and the observation group was treated with laparoscopic common bile duct exploration therapy.The operation cost,operation time,postoperative hospital stay,complications and recurrence rates of the two groups were recorded and compared.Results The operation cost of the observation group(13.25±1.85)thousand yuan was significantly lower than that of the control group(15.88±1.69)thousand yuan.The operation time of the observation group(68.95±14.1)min was significantly shorter than that of the control group(120.21±25.13)min.The postoperative hospital stay of the observation group(5.67±2.66)d was significantly shorter than that of the control group(7.86±2.31)d,the difference was statistically significant(t=6.638,11.250,3.931,P<0.001);There was no significant difference in the incidence of complications between the two groups(χ^(2)=0.180,P=0.671).The removal rate of 100%in the observation group was significantly higher than that of 85%in the control group.The recurrence rate of the observation group was 0%higher than(15%)of the control group,and the difference was statistically significant(χ^(2)=4.505,4.505,P<0.05).Conclusion The laparoscopic common bile duct exploration therapy has high safety and low operation cost,and it is worthy of clinical promotion and application.