LC+LCBDE+PS治疗胆囊结石合并胆总管结石的临床观察

Clinical Observation of LC+LCBDE+PS in the Treatment of Cholecystolithiasis Complicated with Common Bile Duct Stones

目的:探讨胆囊结石合并胆总管结石行腹腔镜胆囊切除(LC)+胆总管探查(LCBDE)+一期缝合(PS)治疗的效果。方法:选择2017年2月-2020年4月于本院就诊的胆囊结石合并胆总管结石患者84例,按随机数字表法将其分为治疗组和对照组,每组42例。治疗组行一步法术式治疗,对照组行分步法术式治疗。比较两组术中、术后情况和炎性因子指标,观察并发症发生情况。结果:治疗组残余结石率为2.38%,与对照组的4.76%比较,差异无统计学意义(P>0.05)。两组手术用时、术中出血量比较,差异均无统计学意义(P>0.05);治疗组住院费用少于对照组,术后住院时间短于对照组,差异均有统计学意义(P<0.05)。术前和术后1 d,两组IL-6、CRP水平比较,差异均无统计学意义(P>0.05);术后1 d,两组IL-6、CRP水平均高于术前,差异均有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:一步法术式与分步法术式治疗胆囊结石合并胆总管结石患者效果相当,安全性相似,但前者存在治疗费用低、住院时间短等优点。

Objective:To investigate the effect of laparoscopic cholecystectomy(LC)+common bile duct exploration(LCBDE)+primary suture(PS)for cholecystolithiasis complicated with common bile duct stones.Method:A total of 84 patients with cholecystolithiasis complicated with common bile duct stones treated in our hospital from February 2017 to April 2020 were selected,they were divided into treatment group and control group according to random number table method,42 cases in each group.The treatment group was treated with one-step method,the control group was treated with step-step method.The intraoperative and postoperative conditions and inflammatory factors of the two groups were compared,and the incidence of complications was observed.Result:The residual stone rate in the treatment group was 2.38%,compared with 4.76%in the control group,there was no significant difference(P>0.05).Comparison of operative time and intraoperative blood loss between the two groups,there were no significant differences(P>0.05);the hospitalization cost of the treatment group was less than that of the control group,the postoperative hospitalization time was shorter than that of the control group,the differences were statistically significant(P<0.05).Before and 1 day after surgery,comparison of IL-6 and CRP levels between the two groups,there were no significant differences(P>0.05);1 day after surgery,IL-6 and CRP levels in both groups were higher than those before surgery,the differences were statistically significant(P<0.05).Comparison of postoperative complication rate between the two groups,there was no significant difference(P>0.05).Conclusion:One-step and step-step methods have similar efficacy and safety in the treatment of patients with cholecystolithiasis complicated with choledocholithiasis,but the former has advantages of low treatment cost and short hospitalization time.