腹腔镜联合胆道镜经胆囊管微切开胆总管取石术临床研究——单位中心经验

Clinical study of laparoscopy combined with choledochoscope for choledocholithotomy via cystic duct

目的探讨腹腔镜联合胆道镜经胆囊管微切开胆总管取石术的临床效果。方法研究纳入2017年3月至2019年3月进贤县人民医院普外科收治的胆总管结石患者55例,其中行腹腔镜联合胆道镜经胆囊管微切开胆总管取石治疗30例(腔镜组),传统开腹手术治疗25例(开腹组),比较两组术中的出血量、胃肠功能恢复时间、留置引流管时间、住院总时间、肝功能情况、术后并发症发生率、复发率等临床指标。结果与传统开腹组相比,腔镜组在术中的出血量(51.51±2.83ml vs 84.36±2.37ml,P=0.005)、胃肠功能恢复时间(1.57±0.41d vs 2.34±0.22d,P=0.000)、留置引流管时间(5.54±2.63d vs 7.38±3.91d,P=0.000)、住院总时间(9.41±3.72d vs 12.52±4.01,P=0.003)、术后并发症发生率(3.33%vs 12%,P=0.002)等方面均占优势(P<0.05)。结论腹腔镜联合胆道镜经胆囊管微切开胆总管取石术较开腹手术,具有创伤小、恢复快、并发症发生率较低、短期恢复快的优势,临床有进一步推广价值。

Objective To investigate the clinical effect of laparoscopic combined with choledochoscopic choledocholithotomy through cystic duct and its influence on postoperative quality of life.Methods From March 2017 to March 2019,55 patients with choledocholithiasis in general surgery department of Jinxian County People's hospital were included in the study,including 30 patients with choledocholithiasis treated by laparoscopy combined with choledochoscope through cystic duct micro incision as endoscopic group and 25 patients treated by traditional laparotomy as laparotomy group.The amount of intraoperative blood loss,the recovery time of gastrointestinal function,the duration of indwelling drainage tube,the total length of hospital stay,the liver function,the incidence of postoperative complications and the recurrence rate were compared between the two groups.Results Compared with the traditional open group,the intraoperative blood loss(51.51±2.83ml vs 84.36±2.37ml,P=0.005),gastrointestinal function recovery time(1.57±0.41d vs 2.34±0.22d,P=0.000),indwelling drainage tube time(5.54±2.63d vs 7.38±3.91d,P=0.000),total hospitalization time(9.41±3.72d vs 12.52±4.01,P=0.003),and the incidence of postoperative complications(3.33%vs 12%,P=0.002)in endoscopic group were better(P<0.05).Conclusion Compared with open surgery,laparoscopic combined choledochoscope microincision choledocholithotomy through gallbladder duct has advantages of less trauma,faster recovery,lower complication rate and faster short-term recovery,which is of further clinical value.