双镜联合同期手术治疗胆囊结石合并胆总管结石与分期手术的对照研究

Randomized control study on Double Mirror Combinedin in the same period therapy application in cholecystolithiasis and choledochofithiasis

目的探讨双镜联合同期治疗胆囊结石合并胆总管结石的临床应用效果.方法选择2019年1月-2022年3月收治的胆囊结石合并胆总管结石患者146例,按照手术类型分为双镜联合同期手术治疗组(n=73)与双镜分期手术治疗组(n=73),对比两组患者的一般资料、白细胞计数(WBC)、总胆红素(TBIL)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、血清淀粉酶(AMS)、白细胞介素-6(1L-6)、C反应蛋白(CRP)、总手术时间、术后疼痛时间、肛门排气期间、平均住院时间、手术费用、耗材费用、总住院费用;术后胰腺炎、胆漏、出血、腹腔感染等指标.结果两组分别完成69、68例,双镜联合同期手术治疗患者总手术时间[(133.94±21.17)min vs.(158.64±21.22)min,P<0.001]、术后疼痛时间[(110.6±23.7)h vs.(173.6±14.8)h,P<0.001]、肛门排气时间[(115.61±33.1)h vs.(164.8±31.8)h,P=0.005]、平均住院时间[12(6~14)]d vs.[14(9~22)d,P<0.001]、较对照组缩短,总住院费用[(35432.10±2784.17)元vs.(56982.16±4384.54)元,P<0.001]较对比组降低,差异有统计学意义.两种治疗方式在WBC、TBIL、AST、ALP、AMS、IL-6、CRP、手术费用、耗材费用,术后胰腺炎、胆漏、出血、腹腔感染差异无统计学意义(P>0.05).结论采用双镜联合同期治疗胆囊结石合并胆总管结石方式适用范围广,术后恢复快,减少花费,缩短住院时间,临床有一定优势.

Objective To study the double mirror treat cystic stone combined in the same period and effect of clinical application of extrahepatic bile duct stones.Methods In January 2019 to March 2022,patients with gallbladder and extrahepatic bile duct stones 146 cases,divided into the double mirror combined therapy with the same period treatment group,(n=73)according to the mode of operation,and laparoscopy combined and used by the duodenum mirror stepped treatmentgroup(n=73).general data,umera-tion of leukocyte(WBC),total bilirubin(TBIL),glutamic oxalacetic transaminase(AST),Alkaline phosphatase(ALP),serum amyl-ase(AMS),interleukin-6(IL-6),C-reactive protein(CRP),total operation time,postoperative pain duration,anus exhausting time,average cure time,surgery cost,Supplies expense,hospitalization expenses,post-ERCP pancreatitis,bile leakage,hemorrhage and intra-abdominal infection were compared between the two groups.Results The two groups completed 69,68 cases respectively,In the double mirror combined therapy with the same period treatment group,and the laparoscopy combined and used by the duodenum mirror stepped treatment group,the total operation time was[(133.94±21.17)min vs.(158.64±21.22)min,P<0.001],the postoperative pain duration[(110.6±23.7)h vs.(173.6±14.8)h,P<0.001],the anus exhausting time[(115.61±33.1)h vs.(164.8±31.8)h,P=0.005],the average cure time{[12(6~14)d vs.14(9~22)]d,P<0.001},the hospitalization expenses[(35432.10±2784.17)yuan vs.(56982.16±4384.54)yuan,P<0.001].All the things mentioned above were statistically significantly different.There was no significant difference in the surgery cost,Supplies expense,WBC,TBIL,AST,ALP,AMS,IL-6,CRP,post-ERCP pancreatitis,bile leakage,hemorrhage,intra-abdominal infection.Conclusion The double mirror combined with simultaneous treatment of choledoeholithiasis The postoperative recovery is faster,the cost is reduced and the hospital stay is shortened,Clinical has certain advantage.