多镜联合免T管手术在胆囊结石合并胆总管结石治疗中的应用

Effect of multi-lens combined with T-tube-free operation in the treatment of cholecystolithiasis complicat⁃ed with common bile duct stones

目的观察多镜联合免T管手术治疗胆囊结石合并胆总管结石的效果。方法145例手术治疗胆囊结石合并胆总管结石患者,分为观察组89例、对照组56例,观察组按胆总管直径选择免T管手术方案,对照组采用腹腔镜下胆总管探查取石术(LCBDE)+T管引流术,观察并记录两组临床疗效及术后并发症发生情况。结果两组均顺利完成手术,观察组中腹腔镜下胆囊切除术(LC)+同步内镜逆行胰胆管造影(ERCP)+内镜下鼻胆管引流术(ENBD)13例、经胆囊管胆管镜胆总管探查术(LTCBDE)19例、LCBDE+一期缝合+同步ERCP+ENBD 57例。与对照组比较,观察组结石取净率高、残余结石率及再手术率低(P均<0.05)。与对照组比较,观察组手术时间长、术后胆管引流时间短、腹腔引流时间短、术后疼痛NRs评分低(P均<0.05)。与对照组比较,观察组Kolcaba心理评分及生活质量SF-36评分高(P均<0.05)。与对照组比较,观察组、血淀粉酶升高>3倍发生率高,胆漏、残余结石、胆管狭窄、胆管引流管阻塞发生率低(P均<0.05)。结论多镜联合免T管手术治疗胆囊结石合并胆总管结石效果较好,严重并发症少,患者舒适度高、远期生活质量好。

Objective To observe the effect of multi-lens combined with T-tube-free surgery in the treatment of cholecystolithiasis combined with common bile duct stones.Methods Totally 145 cases of surgical treatment of patients with cholecystolithiasis complicated with common bile duct stones were divided into the observation group of 89 cases,and control group of 56 cases.Patients in the observation group underwent T-tube operation scheme according to the common bile duct diameter,while patients in the control group adopted the laparoscopic common bile duct exploration(LCBDE)+T-tube drainage.We observed and recorded the clinical curative effects and postoperative complications in the two groups.Results The operation was successfully completed in both groups.In the observation group,13 cases underwent laparoscopic cholecystectomy(LC)+synchronous endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic nasobiliary drainage(ENBD),19 cases underwent laparoscopic transcystic common bile duct exploration(LTCBDE),and 57 cases underwent LCBDE+primary suture+synchronous ERCP+ENBD.Compared with the control group,the observation group had a higher stone removal rate,a lower residual stone rate and a lower reoperation rate(all P<0.05).Compared with the control group,the operation time of the observation group was longer,the postoperative biliary drainage time was shorter,the abdominal drainage time was shorter,and the postoperative pain NRs score was lower(all P<0.05).Compared with the control group,the Kolcaba psychological score and SF-36 score of quality of life in the observation group were higher(both P<0.05).Compared with the control group,the incidence of blood amylase which increased>3 times in the observation group was higher,and the incidences of bile leakage,residual stones,bile duct stenosis and biliary drainage obstruction were lower(all P<0.05).Conclusion Multi-lens combined with T-tube-free surgery for cholecystolithiasis combined with common bile duct stones is effective,with fewer serious complications,high comfort and good longterm quality of life.