腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的效果及价值分析

Analysis of the Effect and Value of Laparoscopy Combined with Choledochoscopy in the Treatment of Cholecystolithiasis Combined with Choledocholithiasis

目的 探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石(cholecystolithiasis with choledocholithiasis,CWC)的效果及价值。方法 方便选取2019年1月—2021年12月永安市立医院收治的122例CWC患者为研究对象,以随机数表法分为研究组(61例)与对照组(61例)。研究组行腹腔镜胆囊切除与胆总管切开胆道镜取石T管引流术,对照组采取常规开腹胆囊切除联合胆总管切开取石T管引流术。针对两组术中与术后情况、术前与术后7 d的肝功能指标、结石残留率与并发症情况进行比较。结果 研究组术中出血量(48.52±5.56)mL、术后首次排气时间(28.65±4.56)h、住院时间(5.65±2.55)d优于对照组(70.65±4.58)mL、(36.46±5.00)h、(8.03±2.69)d,差异有统计学意义(t=23.994、9.014、5.015,P<0.05),两组手术操作时间比较,差异无统计学意义(P>0.05)。术后7 d研究组ALT(62.21±5.56)U/L、ALP(82.65±5.26)U/L、TBIL(22.65±5.23)μmol/L低于对照组(70.69±5.56)U/L、(95.65±5.77)U/L、(28.65±7.56)μmol/L,差异有统计学意义(t=8.423、13.004、5.098,P<0.05)。研究组结石残留率(3.28%)与对照组(0.00%)比较,差异无统计学意义(χ^(2)=0.508,P>0.05),研究组并发症发生率(3.28%)低于对照组(14.75%),差异有统计学意义(χ^(2)=4.896,P<0.05)。结论 CWC患者应用腹腔镜联合胆道镜治疗效果确切,有助于减少失血量、加快恢复、降低并发症发生率,抑制肝功能损伤。

Objective To explore the effect and value of laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis with choledocholithiasis(CWC).Methods 122 CWC patients admitted to Yong´an Municipal Hospital,from January 2019 to December 2021 were conveniently selected as the study objects,and divided into study group(61 cases)and control group(61 cases)by the random number table.The study group underwent laparoscopic cholecystectomy with choledochoscopy for stone extraction and T-tube drainage,while the control group underwent conventional open cholecystectomy combined with choledochotomy for stone extraction and T-tube drainage.The intraoperative and postoperative conditions,preoperative and postoperative liver function indexes,stone residue rate and complications were compared between the two groups.Results Intraoperative bleeding(48.52±5.56)mL,time to first postoperative bleeding(28.65±4.56)h,and hospital stay(5.65±2.55)d in the study group were better than the control group(70.65±4.58)mL,(36.46±5.00)h,and(8.03±2.69)d,the difference was statistically significant(t=23.994,9.014,5.015,P<0.05).There was no statistically significant difference in the operation time between the two groups(P>0.05).ALT(62.21±5.56)U/L,ALP(82.65±5.26)U/L,and TBIL(22.65±5.23)μmol/L in the study group at 7 d postoperatively were lower than the control group(70.69±5.56)U/L,(95.65±5.77)U/L,and(28.65±7.56)μmol/L,the difference was statistically significant(t=8.423,13.004,5.098,P<0.05).Compared the stone residue rate in the study group(3.28%)and the control group(0.00%),the difference was not statistically significant(χ^(2)=0.508,P>0.05).The complication rate in the study group(3.28%)was lower than the control group(14.75%),the difference was statistically significant(χ^(2)=4.896,P<0.05).Conclusion The application of laparoscopy combined with choledochoscopy for CWC patients is effective,helping to reduce blood loss,accelerate recovery,reduce the rate of complications,and inhibit liver function damage.