腹腔镜胆道镜联合钬激光碎石技术在复杂嵌顿胆管结石治疗中的应用价值研究

Application value of laparoscopic common bile duct exploration and choledochoscopy combined with holmium laser lithotripsy in the treatment of complex incarcerated bile duct stones

目的:探讨腹腔镜胆道镜联合钬激光碎石技术在复杂嵌顿胆管结石治疗中的应用价值。方法:采用前瞻性随机对照研究,选取2018年1月至2019年12月郑州大学附属郑州中心医院肝胆胰外科收治的90例复杂嵌顿胆管结石合并胆囊结石患者,根据入组标准随机分为钬激光组(48例)和对照组(42例)。术后随访3~12个月,比较两组患者术前术中资料、术后恢复情况及并发症发生情况。结果:两组患者均完成手术并治愈出院,无围术期死亡。两组患者术前一般资料、术中出血量、术后进食时间比较,差异均无统计学意义(均P>0.05);钬激光组手术时间、术后住院时间、住院总费用均明显低于对照组,差异有统计学意义(P<0.05)。钬激光组术后发生结石残留率明显低于对照组(2.1%vs 16.7%),差异有统计学意义(χ^(2)=4.219,P<0.05);两组患者术后均无胆漏、胆道出血、胆管狭窄等并发症发生。钬激光组行胆管一期缝合术比例显著高于对照组(6.7%vs 0),差异有统计学意义(χ^(2)=5.763,P<0.05)。结论:腹腔镜胆道镜联合钬激光碎石技术可显著提高复杂嵌顿胆管结石的清除率,明显降低患者住院费用、缩短手术时间及术后住院时间,同时有利于胆管一期缝合术开展,值得临床推广应用。

Objective:To investigate the application value of laparoscopic common bile duct exploration and choledochoscopy combined w ith holmium laser lithotripsy in the treatment of complex incarcerated bile duct stones.Methods:The prospective randomized controlled study w as conducted.The total of 90 patients w ith complex incarcerated bile duct stones and cholecystolithiasis w ho w ere admitted to Zhengzhou Central Hospital affiliated to Zhengzhou University from January2018 to December 2019 w ere collected.According to the inclusion criteria,all patients w ere randomly divided into holmium laser group(48 cases)and control group(42 cases).Preoperative and intraoperative data,postoperative recovery and complications w ere compared betw een the tw o groups.Results:Patients in both groups were cured and discharged without perioperative death.There was no statistically significant difference betw een the tw o groups in preoperative general information,intraoperative blood loss and postoperative feeding time(all P>0.05).The operation time,postoperative hospital stay and total hospital expense in the holmium laser group w ere significantly low er than those in the control group(P<0.05).The postoperative calculus residual rate in the holmium laser group w as significantly low er than that in the control group(2.1%vs 16.7%,P<0.05).No postoperative complications such as biliary leakage,biliary tract bleeding and bile duct stricture occurred in the tw o groups.The holmium laser group underw ent primary bile duct suture w as significantly higher than the control group(16.7%vs 0,P<0.05).Conclusions:Laparoscopic common bile duct exploration and choledochoscopy combined w ith holmium laser lithotripsy can significantly improve the clearance rate of complex incarcerated bile duct stones,reduce the patient’s total hospital expense,shorten the operation time and postoperative hospital stay.Furthermore,it is conducive to the development of primary bile duct suture and is w orthy of clinical application.