腹腔镜胆总管切开取石Ⅰ期缝合术治疗肝外胆管结石的疗效分析

Efficacy Analysis of Laparoscopic Common Bile Duct Incision and Phase Ⅰ Suture in the Treatment of Extrahepatic Bile Duct Stones

目的 观察腹腔镜胆总管切开取石Ⅰ期缝合术治疗肝外胆管结石的疗效。方法 选择2018年5月—2020年5月于该院治疗的50例肝外胆管结石患者,按随机数字表法将其分为两组,各25例。两组均采用腹腔镜胆总管切开取石术治疗,术后观察组采用Ⅰ期缝合术治疗,对照组采用T管引流术治疗。比较两组临床指标、残石率、并发症及生活质量。结果 观察组手术时间(105.63±31.98)min、排气时间(25.41±4.86)h及住院时间(6.08±1.46)d短于对照组,视觉模拟评分法(VAS)评分(2.83±0.64)分低于对照组,差异有统计学意义(t=2.177、5.105、6.338、3.270,P<0.05);观察组并发症总发生率(4.00%)低于对照组,差异有统计学意义(χ^(2)=4.878,P<0.05);术后观察组健康状况量表(SF-36)评分(81.64±3.09)分高于对照组,差异有统计学意义(t=5.466,P<0.05);两组术中出血量、腹腔引流时间及残石率对比,差异无统计学意义(P>0.05)。结论 肝外胆管结石患者采用腹腔镜胆总管切开取石Ⅰ期缝合术治疗行之有效,具有并发症少、术后疼痛轻微及恢复快速等优点,能够促使患者术后早期下床活动,提高患者生活质量,可能成为肝外胆管结石治疗的首选术式。

Objective To observe the curative effect of laparoscopic choledocholithotomy in the treatment of extrahepatic bile duct stones.Methods 50 patients with extrahepatic bile duct stones who were treated in the hospital from May 2018 to May 2020 were selected.They were divided into two groups according to the random number table method,with 25 cases in each group.Both groups were treated with laparoscopic choledocholithotomy,postoperative observation group was treated with I-stage suture,and the control group was treated with T-tube drainage.The clinical indicators,residual stone rate,complications and quality of life were compared between the two groups.Results The operation time(105.63±31.98) min,exhaust time(25.41±4.86) h and hospital stay(6.08±1.46) d in the observation group were shorter than those in the control group,and the visual analogue scale(VAS) score(2.83±0.64) points was lower than that in the control group,the difference was statistically significant(t=2.177,5.105,6.338,3.270,P<0.05);the total incidence of complications in the observation group(4.00%) was lower than that in the control group,and the difference was statistically significant(χ~2=4.878,P<0.05);the health status scale(SF-36) score of the observation group after surgery(81.64±3.09) points was higher than that of the control group,and the difference was statis tically significant(t=5.466,P<0.05).There was no significant difference in the amount of blood loss,abdominal drainage time and residual stone rate(P>0.05).Conclusion Laparoscopic choledocholithotomy for patients with extrahepatic bile duct stones is effective and has the advantages of less complications,mild postoperative pain and rapid recovery.It can prompt patients to get out of bed early after operation and improve their quality of life,which may become the first choice for the treatment of extrahepatic bile duct stones.