LC+LCBDE+PDC在胆总管结石合并胆囊结石患者中的应用价值探讨

Application value of LC+LCBDE+PDC in patients with choledocholithiasis and cholecystolithiasis

目的 探讨腹腔镜胆囊切除+胆总管切开取石+胆管一期缝合术(LC+LCBDE+PDC)在胆总管结石合并胆囊结石患者中的应用价值。方法 选取2020年6月—2022年6月分别接受腹腔镜胆囊切除+胆总管切开取石+胆管一期缝合术(LC+LCBDE+PDC)治疗的51例胆总管结石合并胆囊结石患者作为LCBDE组,同期选取接受内镜逆行性胰胆管造影(ERCP)+LC治疗的29例胆总管结石合并胆囊结石患者作为ERCP组;对两组患者临床资料进行回顾性分析。结果 LCBDE组手术时间、住院时间、结石清除率均显著优于ERCP组(P<0.05),两组术后肛门排气时间比较差异不显著(P>0.05);治疗前两组焦虑自评量表(SAS)、抑郁自评量表(SDS)、SF-36评分比较差异不显著(P>0.05),治疗后两组SAS、SDS、SF-36评分均得到显著改善(P<0.05),且术后LCBDE组SAS、SDS、SF-36评分均显著优于ERCP组(P<0.05);LCBDE组并发症发生率显著低于ERCP组(P<0.05)。结论 与ERCP+LC相比,LC+LCBDE+PDC用于治疗胆总管结石合并胆囊结石有效性和安全性均更高,且能更好地改善患者负面情况和生活质量,值得临床借鉴推广。

Objective To investigate the application value of laparoscopic cholecystectomy+laparoscopic common bile duct exploration+primary duct closure(LC+LCBDE+PDC)in patients with choledocholithiasis and cholecystolithiasis.Methods From June 2020 to June 2022,51 patients with choledocholithiasis combined with cholecystolithiasis who underwent LC+LCBDE+PDC in our hospital were selected as LCBDE group.At the same time,29 patients with choledocholithiasis combined with cholecystolithiasis treated with endoscopic retrograde cholangiopancreatography(ERCP)+LC were selected as ERCP group.The clinical data of the two groups were retrospectively analyzed.Results The operation time,hospital stay,and stone clearance rate in the LCBDE group were significantly better than those in the ERCP group(P<0.05),and there was no significant difference in the postoperative anal exhaust time between the two groups(P>0.05).The scores of Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),and SF-36 were not different between the two groups before treatment(P>0.05),but were all improved after treatment(P<0.05),and the scores in the LCBDE group were significantly better than those in the ERCP group(P<0.05).The incidence of complications in the LCBDE group was significantly lower than that in the ERCP group(P<0.05).Conclusion Compared with ERCP+LC,LC+LCBDE+PDC has higher efficacy and safety in patients with choledocholithiasis combined with gallbladder stones,and can better improve the negative conditions and quality of life in patients,which is worthy of clinical reference and promotion.