LCDE与开腹手术治疗胆总管结石的临床对比研究

Clinical Comparison of LCDE and Open Operation in the Treatment of Choledocholithiasis

目的 探究与分析腹腔镜胆总管探查(laparoscopic common bile duct exploration,LCDE)手术与开腹手术治疗胆总管结石的效果。方法 回顾性分析2015年2月—2020年2月兴化市第五人民医院收治的胆总管结石患者46例的临床资料,按照不同手术治疗方法分为LCDE组(n=22)与开腹组(n=24),LCDE组给予腹腔镜胆道探查取石术治疗胆总管结石,开腹组给予开腹手术治疗胆总管结石。对比两组围术期指标、术后并发症发生率及手术治疗前后的创伤指标。结果 LCDE组切口长度、手术时间、术中出血量、引流时间、排气时间、住院费用、住院时间分别为(0.86±0.18)cm、(97.54±16.55)min、(85.64±23.10)mL、(96.80±21.33)min、(2.13±0.57)d、(7 560.14±284.33)元、(5.26±2.10)d,均优于开腹组,差异有统计学意义(t=16.318、3.203、5.560、6.893、8.960、29.170、4.240,P<0.05)。LCDE组手术后WBC计数、中性粒细胞比例、淋巴细胞比例分别为(7.23±1.65)×10~9/L、(57.17±3.75)%、(37.60±3.25)%,均优于开腹组,差异有统计学意义(t=5.827、15.635、25.865,P<0.05)。结论 LCDE与开腹手术相比治疗胆总管结石的围术期指标表现更好,不容易造成明显的创伤,安全性及可行性均较高。

Objective To explore and analyze the efficacy of LCDE and open surgery in the treatment of choledocholithiasis.Methods The clinical data of 46 patients with choledocholithiasis admitted to Xinghua Fifth People´s Hospital from February 2015 to February 2020 were retrospectively analyzed.They were divided into LCDE group(n=22)and laparotomy group(n=24)according to different surgical methods.The LCDE group was treated with laparoscopic choledocholithotomy for choledocholithiasis,and the laparotomy group was treated with choledocholithiasis.The perioperative indexes,postoperative complications and trauma indexes before and after surgical treatment were compared between the two groups.Results Incision length,operation time,intraoperative blood loss,drainage time,exhaust time,hospitalization cost and hospitalization time in LCDE group were(0.86±0.18)cm,(97.54±16.55)min,(85.64±23.10)mL,(96.80±21.33)min,(2.13±0.57)d,(7560.14±284.33)yuan,(5.26±2.10)d,respectively,were better than those in the laparotomy group,and the difference was statistically significant(t=16.318,3.203,5.560,6.893,8.960,29.170,4.240,P<0.05).The WBC count,neutrophil ratio and lymphocyte ratio of the LCDE group were(7.23±1.65)×109/L,(57.17±3.75)%and(37.60±3.25)%,respectively,were better than those in the laparotomy group,and the difference was statistically significant(t=5.827,15.635,25.865,P<0.05).Conclusion Compared with open surgery in the treatment of choledocholithiasis,LCDE has better performance in perioperative indexes and is less likely to cause obvious trauma,with higher safety and feasibility.