腹腔镜联合胆道镜治疗肝外胆道结石的临床有效性

Clinical Efficacy of Laparoscopy Combined with Choledochoscopy in the Treatment of Extrahepatic Biliary Calculi

目的评价患有肝外胆道结石的患者联用胆道镜+腹腔镜的效果。方法回顾研究2021年4月至2022年4月因肝外胆道结石在本院接受手术治疗的60例患者的基本资料,将采取传统开放性手术的28例患者设为对照组,将采取胆道镜+腹腔镜手术的32例患者设为研究组。对比两组的手术时间、术后胃肠功能恢复时间、术后引流时间、住院时间、手术失血量、并发症发生率、结石清除率。结果与对照组相比,研究组的术后胃肠功能恢复时间、住院时间明显缩短,手术失血量明显减少,提示差异有统计学意义(P<0.05);研究组的手术时间与对照组较为接近,提示差异无统计学意义(P>0.05)。与对照组相比,研究组的并发症发生率相对较低(6.25%vs.32.14%),提示差异有统计学意义(χ^(2)=6.687,P=0.010)。研究组、对照组结石清除率相近(93.75%vs.96.43%),提示差异无统计学意义(χ^(2)=0.226,P=0.635)。结论患有肝外胆道结石的患者可联用胆道镜+腹腔镜进行治疗,虽然手术时间和结石清除率与开放性手术相近,但安全性很高,术后患者恢复更快,因此在满足适应证的情况下可为肝外胆道结石患者选择胆道镜+腹腔镜联合手术。

Objective To evaluate the effect of choledochoscopy combined with laparoscopy in patients with extrahepatic biliary calculi.Methods The basic data of 60 patients with extrahepatic biliary calculi who underwent surgical treatment in our hospital from April 2021 to April 2022 were retrospectively studied.28 patients who underwent traditional open surgery were set as the control group,and 32 patients who underwent choledochoscopy+laparoscopic surgery were set as the research group.The operation time,postoperative gastrointestinal function recovery time,postoperative drainage time,hospital stay,blood loss,complication rate and stone clearance rate were compared between the two groups.Results Compared with the control group,the recovery time of gastrointestinal function and hospital stay in the study group were significantly shorter,and the blood loss was significantly reduced,suggesting that the statistical difference was very significant(P<0.05).The operation time of the study group was close to that of the control group,suggesting that the statistical difference was not significant(P>0.05).Compared with the control group,the incidence of complications in the study group was relatively low(6.25%vs.32.14%),suggesting that the statistical difference was very significant(χ^(2)=6.687,P=0.010).The stone clearance rates of the study group and the control group were similar(93.75%vs.96.43%),suggesting that the statistical difference was not significant(χ^(2)=0.226,P=0.635).Conclusion Patients with extrahepatic biliary calculi can be treated with choledochoscopy+laparoscopy.Although the operation time and stone clearance rate are similar to those of open surgery,the safety is very high,and the postoperative recovery can be faster.Therefore,choledochoscopy+laparoscopy can be selected for patients with extrahepatic biliary calculi when the indications are met.