腹腔镜胆总管探查术联合腹腔镜胆囊切除术与经内镜逆行胰胆管造影术联合腹腔镜胆囊切除术治疗胆总管结石伴胆囊结石的效果分析

Effect analysis of laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy in the treatment of common bile duct calculi and cholecystolithiasis

目的分析腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)联合LC治疗胆总管结石伴胆囊结石的临床效果和安全性。方法采用分层随机法将2020年2月至2022年2月在甘肃医学院附属医院接受手术治疗的胆总管结石伴胆囊结石的患者300例,分为LCBDE+LC组、ERCP+LC组,每组各150例。两组患者分别采用LCBDE+LC、ERCP+LC治疗,对比两组患者的手术相关指标以及术后恢复情况。结果两组患者均未出现中转开腹病例,ERCP+LC组患者的手术时间、术中出血量均优于LCBDE+LC组,但腹腔引流管使用率低于LCBDE+LC P P组(<0.05)。两组患者腹腔粘连、取石成功率以及净石率差异无显著性(>0.05)。LCBDE+LC组患P者的术后排气时间、恢复活动时间均短于ERCP+LC组(<0.05)。两组患者的术后并发症发生情况无显P著差异(>0.05)。结论LCBDE+LC与ERCP+LC治疗胆总管结石伴胆囊结石均能取得良好的手术效果,但是手术方法的选择还需根据患者的年龄、临床症状等多方面因素综合考虑,如此才能提高治疗成功率。

Objective To analyze laparoscopic common bile duct exploration(LCBDE)combined with laparoscopic cholecystectomy(LC)and endoscopic retrograde pancreatic angiography(ERCP)combined with LC in the treatment of common bile duct calculi clinical effect and safety of gallstone disease.Method A total of 300 patients with choledocholithiasis and cholecystolithiasis undergoing surgical treatment in The Affiliated Hospital of Gansu Medical College from February 2020 to February 2022 were randomly divided into LCBDE+LC group and ERCP+LC group,with 150 cases in each group.Patients in the two groups were treated with LCBDE+LC and ERCP+LC respectively,and the operative indicators and postoperative recovery of patients in the two groups were compared.Result There was no case of conversion to laparotomy in the two groups.The operative time and intraoperative blood loss in the ERCP+LC group were less than those in the LCBDE+LC group,but the utilization rate of abdominal drainage tube was lower than that in the LCBDE+LC group(P<0.05).There were no significant differences in the success rate of intraperitoneal adhesion,stone removal and stone removal rate between 2 groups(P>0.05).The postoperative exhaust time and recovery time of PATIENTS in LCBDE+LC group were shorter than those in ERCP+LC group(P<0.05).There was no significant difference in the incidence of postoperative complications between 2 groups(P>0.05).Conclusion Both LCBDE+LC and ERCP+LC can achieve good surgical results in the treatment of choledocholithiasis and cholecystolithiasis,but the choice of surgical method should be considered comprehensively according to the age of patients,clinical symptoms and other factors,so as to improve the success rate of treatment.