腹腔镜胆囊切除+胆总管切开联合胆道镜探查取石术治疗肝硬化伴胆总管结石患者的效果与安全性

Effect and safety of laparoscopic cholecystectomy+choledochotomy combined with choledochoscopy exploration and lithotripsy in the treatment of patients with liver cirrhosis and choledocholithiasis

目的探析腹腔镜胆囊切除+胆总管切开联合胆道镜探查取石术治疗肝硬化伴胆总管结石患者的效果与安全性。方法将84例肝硬化伴胆总管结石患者按照随机数字表法分为开腹组(42例,开腹胆囊切除术+胆总管探查取石术)与双镜组(42例,腹腔镜胆囊切除+胆总管切开联合胆道镜探查取石术)。比较两组的治疗效果。结果双镜组的手术时间、术后禁食时间、住院时间均短于开腹组,出血量少于开腹组(P<0.05);两组的一次性清石率比较,差异不显著(P>0.05)。术后3 d,两组的血清IL-6、CRP、EP水平均有所上升,但双镜组低于开腹组(P<0.05)。术后3 d,两组的血清ALT、AST水平均低于术前(P<0.05),但组间比较,差异不显著(P>0.05)。双镜组的术后并发症总发生率低于开腹组(P<0.05)。结论腹腔镜胆囊切除+胆总管切开联合胆道镜探查取石术治疗肝硬化伴胆总管结石患者可减小手术创伤,减轻炎症及应激反应,减少术后并发症。

Objective To explore the effect and safety of laparoscopic cholecystectomy+choledochotomy combined with choledochoscopy exploration and lithotripsy in the treatment of patients with liver cirrhosis and choledocholithiasis.Methods A total of 84 patients with liver cirrhosis and choledocholithiasis were divided into laparotomy group(42 cases,open cholecystectomy+common bile duct exploration and lithotripsy)and double mirror group(42 cases,laparoscopic cholecystectomy+choledochotomy combined with choledochoscopy exploration and lithotripsy)by the random number table method.The therapeutic effects of the two groups were compared.Results The operation time,postoperative fasting time and hospital stay in the double mirror group were shorter than those in the laparotomy group,and the amount of bleeding was less than that in the laparotomy group(P<0.05);there was no significant difference in one-time stone removal rate between the two groups(P>0.05).Three days after operation,the levels of serum IL-6,CRP and EP in the two groups increased,but those in the double mirror group were lower than the laparotomy group(P<0.05).Three days after operation,the levels of serum ALT and AST in the two groups were lower than those before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).The total incidence of postoperative complications in the double mirror group was lower than that in the laparotomy group(P<0.05).Conclusion Laparoscopic cholecystectomy+choledochotomy combined with choledochoscopy exploration and lithotripsy in the treatment of patients with liver cirrhosis and choledocholithiasis can reduce surgical trauma,alleviate inflammation and stress response,and reduce postoperative complications.